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Stenting of unprotected left main coronary artery stenoses: immediate and late outcomes
1Department of Internal Medicine, College of Medicine, University of Ulsan, and Asan Medical Center, Seoul, Korea. sjpark@www.amc.seoul.kr
Insights
Stenting unprotected left main coronary artery (LMCA) stenoses in patients with normal left ventricular function shows promise. This percutaneous intervention may be a safe alternative to coronary artery bypass graft surgery (CABG) in select cases.
Area of Science:
- Interventional Cardiology
- Coronary Artery Disease
- Vascular Stenting
Background:
- Left main coronary artery (LMCA) disease historically contraindicates angioplasty.
- Percutaneous intervention for LMCA stenoses is increasingly explored.
- Unprotected LMCA stenting presents a novel therapeutic avenue.
Purpose of the Study:
- To evaluate immediate and long-term outcomes of unprotected LMCA stenting.
- To assess the safety and efficacy of stenting in patients with normal left ventricular (LV) function.
- To compare stenting outcomes against traditional surgical revascularization.
Main Methods:
- Forty-two patients with unprotected LMCA stenoses and normal LV function underwent stenting.
- Patients received aspirin and ticlopidine post-stent; 14 also received warfarin.
- Close follow-up included monthly calls and 6-month angiography.
Main Results:
- 100% procedural success with no subacute thrombosis.
- 22% angiographic restenosis at 6 months, leading to subsequent procedures or surgery.
- One death occurred post-coronary artery bypass graft surgery (CABG) for restenosis; others remained asymptomatic.
Conclusions:
- Unprotected LMCA stenting is a potentially safe and effective alternative to CABG in carefully selected patients with normal LV function.
- Further research with larger cohorts is necessary to confirm long-term outcomes.
- Percutaneous treatment of LMCA stenoses warrants consideration in specific patient profiles.
Objectives:
We examined the immediate and long-term outcomes after stenting of unprotected left main coronary artery (LMCA) stenoses in patients with normal left ventricular (LV) function.
Background:
Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty. Recently, several reports on protected or unprotected LMCA stenting, or both, suggested the possibility of percutaneous intervention for this prohibited area.
Methods:
Forty-two consecutive patients with unprotected LMCA stenoses and normal LV function were treated with stents. The post-stent antithrombotic regimens were aspirin and ticlopidine; 14 patients also received warfarin. Patients were followed very closely with monthly telephone interviews and follow-up angiography at 6 months.
Results:
The procedural success rate was 100%, with no episodes of subacute thrombosis regardless of anticoagulation regimen. Six-month follow-up angiography was performed in 32 of 34 eligible patients. Angiographic restenosis occurred in seven patients (22%, 95% confidence interval 7% to 37%); five patients subsequently underwent elective coronary artery bypass graft surgery (CABG), and two patients were treated with rotational atherectomy plus adjunct balloon angioplasty. The only death occurred 2 days after elective CABG for treatment of in-stent restenosis. The other patients (without angiographic follow-up) remain asymptomatic.
Conclusions:
Stenting of unprotected LMCA stenoses may be a safe and effective alternative to CABG in carefully selected patients with normal LV function. Further studies in larger patient populations are needed to assess late outcome.