Single-stent crossover technique from distal unprotected left main coronary artery to the left circumflex artery
Toru Naganuma1, Alaide Chieffo, Sandeep Basavarajaiah
1Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
Insights
Single-stenting the left main coronary artery (LMCA) to the left circumflex artery (LCx) shows similar major adverse cardiac events but higher target lesion revascularization (TLR). Alternative strategies may be needed for distal LMCA disease extending into the LCx.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Coronary Artery Disease
Background:
- Percutaneous coronary intervention (PCI) for distal unprotected left main coronary artery (LMCA) disease typically involves stenting the left anterior descending artery (LAD).
- Stenting solely from the LMCA to the left circumflex artery (LCx) is an alternative approach in select cases.
Purpose of the Study:
- To evaluate and compare the clinical outcomes of single-stenting procedures involving distal unprotected LMCA disease.
- Specifically comparing stenting from LMCA to LCx versus LMCA to LAD.
Main Methods:
- A retrospective analysis of 584 patients undergoing single-stenting with drug-eluting stents for distal unprotected LMCA disease between April 2002 and April 2011.
- Comparison of 31 patients who underwent LMCA-LCx stenting with 553 patients who underwent LMCA-LAD stenting.
Main Results:
- At 3-year follow-up, no significant differences in major adverse cardiac events, cardiac death, or myocardial infarction were observed between the LMCA-LCx and LMCA-LAD stenting groups.
- A trend towards higher target lesion revascularization (TLR) was noted in the LMCA-LCx group, which became significant when considering only the stented branch (18.2% vs. 3.0%; P < 0.001).
- Multivariable analysis identified LMCA-LCx stenting as an independent predictor of TLR due to restenosis at the ostium of the stented branch (HR 6.49; P < 0.001).
Conclusions:
- High rates of TLR at the LCx ostium occur regardless of whether LMCA-LCx or LMCA-LAD stenting is performed.
- LMCA-LCx stenting is associated with a high rate of TLR at the LAD ostium as well.
- Alternative treatment strategies should be considered for distal LMCA disease that involves the LCx but not the LAD.
Objectives:
To report the clinical outcomes of single-stenting from distal unprotected left main coronary artery (LMCA) to the left circumflex artery (LCx).
Background:
Percutaneous coronary intervention of distal LMCA is usually performed by stenting into the left anterior descending artery (LAD). In some cases, stenting from LMCA to LCx alone is performed.
Methods:
Between April 2002 and April 2011, single-stenting with drug-eluting stents for distal unprotected LMCA disease was performed in 584 patients. Thirty-one patients underwent LMCA-LCx stenting, who were compared with the remaining 553 LMCA-LAD stented patients.
Results:
At 3-year follow-up, there were no significant differences between LMCA-LCx and LMCA-LAD stenting groups in major adverse cardiac events (24.1% vs. 19.6%; P = 0.540), cardiac death, and myocardial infarction. A trend toward higher target lesion revascularization (TLR) in the LMCA-LCx stenting group was noted. This was significant when the stented branch was only considered (18.2% vs. 3.0%; P < 0.001). In both TLR subgroups, LCx ostium was frequently involved (83.3% in LMCA-LCx vs. 66.2% in LMCA-LAD TLR subgroups; P = 0.39). The LAD ostium was more frequently involved in LMCA-LCx TLR subgroup (83.3% vs. 21.0%; P < 0.001). On the multivariable Cox regression analysis, LMCA-LCx stenting was an independent predictor of TLR for restenosis at the ostium of the stented branch (HR 6.49; 95% CI 2.27-18.53; P < 0.001).
Conclusions:
TLR rate at the LCx ostium is high irrespective of LMCA-LCx or LMCA-LAD stenting. The former also seems to be associated with high TLR at the LAD ostium. It may therefore be important to evaluate alternative strategies for treating distal LMCA disease that extends into the LCx but not LAD.
