Percutaneous transluminal coronary angioplasty of left main coronary artery
Insights
Percutaneous angioplasty of the left main coronary artery demonstrated a 100% technical success rate. Clinical success was 73% overall, and 92% for elective procedures, with a 27% in-hospital mortality rate.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Left main coronary artery disease poses significant risks.
- Percutaneous coronary intervention (PCI) is an alternative to surgical revascularization.
- Outcomes of PCI for left main disease require ongoing evaluation.
Purpose of the Study:
- To analyze the outcomes of percutaneous angioplasty for left main coronary artery lesions.
- To assess technical and clinical success rates in a cohort of patients undergoing left main PCI.
- To evaluate mortality and long-term survival following left main angioplasty.
Main Methods:
- Retrospective analysis of 15 percutaneous angioplasty procedures in 12 patients.
- Procedures included elective and emergency interventions for various angina presentations and myocardial infarction.
- Techniques employed included "kissing balloon" and "kissing wire" methods; femoral access was used.
Main Results:
- 100% technical success rate for all procedures.
- Overall clinical success rate was 73%, with 92% for elective cases.
- In-hospital mortality was 27% (100% in emergency cases, 8% in elective cases).
Conclusions:
- Percutaneous angioplasty of the left main coronary artery is technically feasible with high success rates.
- Clinical outcomes vary significantly between elective and emergency settings.
- Long-term survival in discharged patients was favorable, warranting further investigation.
Abstract:
The present study is a retrospective analysis of 15 percutaneous angioplasty procedures of the left main coronary artery performed in 12 patients (8 males (66%) with a mean age of 64 +/- 12 (range 45-79) years. Twelve dilatations were elective: 8 for unstable angina, 3 for stable angina, and 1 after a recent myocardial infarction. All elective patients were protected with at least 1 patent graft to the distal left coronary artery. Emergency dilatation for evolving myocardial infarction with cardiogenic shock was done in 3 patients. The right coronary artery was dominant in 11 cases. The mean ejection fraction was 49 +/- 18% (range 21-7%). All dilatations were done through the femoral approach. Two dilatations were performed with the "kissing balloon" technique and 2 with the "kissing wire" technique. An intra-aortic balloon counterpulsation was used in 3 cases (21%). In 8 cases (53%), 1 additional coronary artery was dilated in the same session. The technical success rate was 100% and the clinical success rate 73%. For the elective dilatations, the technical success rate was 100% and the clinical success rate 92% (11/12). Four patients died during hospitalisation (27%). The mortality rate was 100% (3/3) for emergency dilatations and 8% (1/12) for elective dilatations (patient with dilatation of 3 vessels and 1 graft in the same session). After a mean follow-up of 25 +/- 28 (rang 1-88) months, the 8 patients discharged from hospital were alive.(ABSTRACT TRUNCATED AT 250 WORDS)
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