Related Experiment Videos
Stenting of "unprotected" left main coronary artery stenoses: early and late results
C J Laruelle1, G B Brueren, S M Ernst
1Department of Interventional Cardiology and Cardiothoracic Surgery, St Antonius Hospital Koekoekslaan, Netherlands.
Insights
Coronary stent implantation for unprotected left main stenosis is effective for stable patients. Urgent procedures in emergency settings showed higher adverse events, indicating it
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Medical Device Technology
Background:
- Unprotected left main coronary artery stenosis poses significant risks.
- Coronary stent implantation is a therapeutic option for complex coronary artery disease.
- Assessing the efficacy of stenting in this critical arterial segment is crucial.
Purpose of the Study:
- To evaluate the short-term and long-term effectiveness of coronary stent implantation.
- Specifically for patients with unprotected left main coronary artery stenosis.
- Comparing outcomes in elective versus emergency procedures.
Main Methods:
- Retrospective follow-up study of 18 consecutive patients.
- Patients underwent coronary stent implantation (Palmaz-Schatz, Microstent, Gianturco-Roubin).
- Outcomes assessed included procedural success and major adverse cardiac events.
Main Results:
- Successful stent implantation in all patients.
- Elective procedures in stable angina patients had no major adverse cardiac events.
- Emergency procedures for unstable angina/myocardial infarction had higher complication rates, including procedural death and need for bypass surgery.
Conclusions:
- Elective coronary stent implantation is safe and effective for selected stable patients with unprotected left main coronary artery stenosis.
- Urgent stent implantation in emergency situations is not a definitive solution and carries higher risks.
- Further research may explore optimized strategies for high-risk emergency cases.
Objective:
To assess short and long term efficacy of coronary stent implantation for unprotected left main coronary artery stenosis.
Design:
Retrospective follow up study.
Setting:
Tertiary referral centre for interventional cardiology and cardiac surgery.
Patients:
Eighteen consecutive patients (12 men; age 70.8 years) between May 1993 and July 1996. Ten patients presented with stable angina and underwent the procedure electively, eight patients presented either with unstable angina or myocardial infarction and underwent the procedure in emergency.
Intervention:
Johnson and Johnson Palmaz-Schatz stents were used in 16 patients, and a Microstent and a Gianturco-Roubin in one patient each. An intra-aortic balloon pump was prophylactively used for two patients in the elective group. In the acute group, six required an intra-aortic balloon pump.
Main Outcome Measures:
Procedural success rate and major adverse cardiac events.
Results:
Successful stent implantation was achieved in all patients. In the elective group, no major adverse cardiac event occurred during the procedure, but one patient had to undergo repeated angioplasty before discharge. All patients of the elective group were discharged alive and there has been one non-cardiac death during a follow up of (mean (SD)) 10 (4) months. In the emergency group, one patient died during the procedure, one patient developed a non Q-wave myocardial infarction, one patient underwent emergency coronary bypass surgery, while another patient died suddenly before hospital discharge. Six patients of the emergency group were discharged alive and there has been one non-cardiac death during a follow up of 7 (4) months.
Conclusions:
Elective stent implantation for unprotected left main coronary artery stenosis is safe and effective in selected stable patients. Urgent stent implantation, however, cannot be considered as a definitive procedure in emergency situation.