Elective percutaneous intervention for unprotected left main coronary artery stenosis complicated with left anterior
Gui-Tang Yang1, Ya-Ling Han, Quan-Min Jing
1Department of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning 110840, China.
Insights
Percutaneous coronary intervention is a safe option for high-risk patients with unprotected left main coronary artery (ULMCA) stenosis and left anterior descending (LAD) chronic total occlusion (CTO). This approach offers feasible treatment for inoperable patients, demonstrating good long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Patients with unprotected left main coronary artery (ULMCA) stenosis and left anterior descending (LAD) chronic total occlusion (CTO) often require bypass surgery.
- However, some patients are inoperable or high-risk surgical candidates.
Purpose of the Study:
- To explore treatment strategies for ULMCA stenosis complicated by LAD CTO.
- To evaluate the efficacy of percutaneous coronary intervention (PCI) in these high-risk patients.
Main Methods:
- Retrospective analysis of 78 patients with ULMCA stenosis and LAD CTO treated with stenting from 2001 to 2009.
- Patients were either young (<40 years) refusing surgery or unsuitable for surgery (e.g., advanced age, comorbidities, high EuroSCORE).
- Four distinct PCI strategies were employed based on lesion characteristics.
Main Results:
- High procedural success rate (94.9%) with no deaths or thromboses.
- In-hospital non-Q-wave myocardial infarction occurred in 6.4% of patients.
- Long-term follow-up (52 months) showed 3.8% cardiac deaths and 5.1% nonfatal myocardial infarctions. Major adverse cardiac events occurred in 16.7%.
Conclusions:
- Percutaneous intervention is a safe and feasible strategy for selected high-risk patients with ULMCA and LAD CTO.
- Individualized therapeutic strategies are key to successful PCI outcomes in this complex patient group.
Background:
The patients with unprotected left main coronary artery (ULMCA) stenosis and chronic total occlusion (CTO) lesions at the left anterior descending (LAD) artery are often recommended for bypass surgery. However, some of these patients are deemed inoperable or are at high risk for surgery. In this study, we explored strategies and evaluated the efficacy of percutaneous coronary intervention for the treatment of ULMCA stenosis complicated by LAD CTO.
Methods:
From November 2001 to July 2009, 78 patients with ULMCA stenosis and LAD CTO lesions were selectively treated with stenting. Six patients (7.7%) refused surgery due to their young age (< or = 40 years), and the other 72 patients (92.3%) were unsuitable for surgery. Reasons for poor surgical candidacy included advanced age (> 80 years), chronic obstructive pulmonary, unsuitable distal target vessels for bypass, EuroSCORE > or = 6, and so on. Four different strategies were applied based on the degree of left main stenosis and the ostial diameter and involvement of the left circumflex.
Results:
Total procedural success was achieved in 94.9%, there were no deaths or thromboses. Five patients (6.4%) experienced non-Q-wave myocardial infarction in hospital. At long-term follow-up ((52 +/- 28) months), there were 3 cardiac deaths (3.8%) and 4 (5.1%) nonfatal myocardial infarctions. Angiographic follow-up was performed in 50 patients (64.1%), and target vessel revascularizations were required in 10 patients (12.8%), among which 4 nonfatal myocardial infarction patients included. The rate of major adverse cardiac events was 16.7% (13/78).
Conclusions:
This study indicates that percutaneous intervention can be performed safely in high risk surgical patients with ULMCA and LAD CTO lesions based on individual therapeutic strategies. It may be feasible to apply this technique in selected patients mentioned above.
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