2000, Number 1
<< Back Next >>
Arch Cardiol Mex 2000; 70 (1)
Stent in protected and unprotected left main coronary artery. Short term results
Farell CJ, Palomo VJA, Abundes VA, Ledesma VM
Language: Spanish
References: 25
Page: 38-45
PDF size: 188.95 Kb.
ABSTRACT
We examined the immediate and short-term outcomes after stenting protected and unprotected left main coronary artery (LMCA) stenoses, in patients with normal ventricular function. Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty, because it has been associated with high procedural morbidity and poor mid-term results. Between february 1995 and february 1999, 596 procedures were performed in 468 patients. Ten patients who had disease involving the left main coronary artery were included. They were not candidates for coronary surgery. The post-stent antithrombotic regimens were aspirin and ticlopidine. The procedural success rate was 100% without episodes of subacute thrombosis. Three to six months follow-up angiography was performed in all, restenosis occurred only in two patients, there were two repeat PTCA (20%) and there were no deaths.
Conclusions: Stenting of unprotected and protected left main coronary artery stenoses may be a safe and effective alternative to surgery in carefully selected patients with normal left ventricular function. The results of our study suggests that when patients have prohibitive surgical risks, elective LMCA angioplasty and/or stenting maybe undertaken with a high procedural success rate as an effective alternative to CABG in carefully selected patients. Further studies in larger patient populations are needed to assess late outcome.
REFERENCES
Ryan T, Faxon D, Gunnar R, Kennedy J, King S, Loop, et al: Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association. Task Force on assessment of diagnostic and therapeutic cardiovascular procedures (subcommittee on percutaneous transluminal coronary angioplasty. Circulation 1998; 78:486-502.
Waller B, Pinkerton C, Foster L: Morphologic evidence of accelerated left main coronary artery stenosis. A late complications of percutaneous transluminal ballon angioplasty of the proximal left main anterior descending coronary artery. J Am Coll Cadiol 1987; 9:1019-1023.
Okeefe J, Hartezer G, Rutherford B, McConahay D, Johnson W, Giorgi L, et al: Left main coronary angioplasty: Early and late results of 127 acute and elective procedures. Am J Cardiol 1989; 64:144-147.
Kells C, Miller R, Henderson A, Lomnicki J, Macdonald R: Left main coronary artery disease progression after percutaneous transluminal coronary angioplasty. Am J Cardiol 1990; 65:513-514.
Eldar M, Schuuhoff N, Herz I, Frankel R, Feld H, Shani J: Results of percutaneous transluminal angioplasty of the left main coronary artery. Am J Cardiol 1991; 68:255-256.
Roubin G, Cannon A, Agrawual S, Dean L, Baxley W, Breland J: Intracoronary stenting for acute and threatened clouse complicating percutaneous transluminal coronary angioplasty. Circulation 1992; 851:916-927.
Ledesma M, Farell J, Astudillo R, Abundes A, Escudero X, Montoya S, et al: Experiencia en el Hospital de Cardiología del Centro Médico Nacional Siglo XXI. Arch Inst Cardiol Mex 1997; 67:101-105.
Villavicencio R, Marchena A, Eid G, Lechuga A, Peña M, Gaspar J, et al: Stent coronario en el infarto agudo del miocardio. Arch Inst Cardiol Mex 1998; 68:18-26.
Waller B, Pinkerton C, Foster L: Morphologic evidence of accelerated left main coronary artery stenosis: A late complication of percutaneous transluminal balloon angioplasty of the proximal left anterior descending coronary artery. J Am Coll Cardiol 1987; 9:1019-1023.
Zampieri P, Colombo A, Almagor Y, Maiello L, Finci L: Results of coronary stenting of ostial lesions. Am J Cardiol 1994; 73:901-903.
Kereaiakes D: Percutaneous transcatheter therapy of aorto-ostial stenoses. Cath Cardiovasc Diagn 1996; 38:292-300.
Macaya C, Alfonso F, Iñiguez A, Goicolea J, Hernández R, Zarco P: Stenting for elastic recoil during coronary angioplasty of the left main coronary artery. Am J Cardiol 1992: 70: 105-107.
Garcia-Robles A, Garcia E, Rico M, Esteban E, Perez del Prado A, Delcan J: Emergency coronary stenting for acute occlusive dissection of the left main coronary artery. Cathet Cardiovasc Diagn 1993; 30:227-229.
Sathe S, Sebastian M, Vohra J, Valentine P: Bail-out stenting for left main coronary artery occlusion following diagnostic angiography. Cathet Cardiovasc Diagn 1994; 31:70-72.
Ellis S, Tamai T, Noboyushi M, Kosuga K, Colombo A, Holmes D, et al: Contemporary percutaneous treatment of unprotected left main coronary stenoses. Initial results from a multicenter registry analysis 1994-1996. Circulation 1997; 96:3867-3872.
LAster S, Rutherford B, McConahay D, Giorgi L: Directional atherectomy of left main stenoses. Cathet Cardiovasc Diagn 1994; 33:317-322.
Hinohara T, Rowe M, Robertson G: Effect of lesion characteristics on outcome of directional coronary atherectomy. J Am Coll Cardiol 1991; 17:1112-1120.
Chauhan A, Zubaid M, Ricci D, Buller Ch, Moscovich M, Mercier B, et al: Left main intervention revisited: Early and late outcome of PTCA and stenting. Cathet Cardiovasc Diagn 1997; 41:21-29.
Lopez J, Kalon K, Ho L, Stoler R, Caputo R, Carrozza J, et al: Percutaneous treatment of protected and unprotected left main coronary stenoses with new devices: Immediate angiographic results and intermediate term follow-up. J Am Coll Cardiol 1997; 29:345-352.
Itoh A, Colombo A, Hall P, Maiello L, Di Mario C, Blengino S, et al: Stenting in protected and unprotected left main coronary artery: Immediate and follow-up results. J Am Coll Cardiol 1996; 27:1 (Suppl A):277.
Silvestri M, Barragan P, Simeoni J, Roquebet P, Bayet G, Sainsous J, et al: Unprotected left main stenting: Preliminary results and follow-up with the first 41 patients. J Am Coll Cardiol 1997; 29 (2; Suppl A):15.
22 Laruelle C, Brueren G, Bal E, Ernest S, Mast G, Suttorp M, et al: Stenting of “unprotected” left main coronary artery stenoses: Early and late results. J Am Coll Cardiol 1997; 29 (2; Suppl A):15.
Jung S, Wook S, Hong M, Cheong S, Whan Ch, Mintz G: Stenting of unprotected left main coronary artery stenoses: Immediate and late outcomes. J Am Coll Cardiol 1998; 31:37-42.
Ellis S, Tamai H, Nobuyoshi M, Colombo A, Holmes D, Kosuga K: Contemporary percutaneous treatment on unprotected left main coronary stenoses. An update from the ULTIMA registry. J Am Coll Cardiol 1997; 29 (2; Suppl A):396.
Cortina R, Fajadet J, Cassagneau B, Jordan C, Laborde J, Laurent J, et al: Stenting of unprotected left main coronary artery stenoses: Methodology, in hospital results and mid-term clinical outcome. J Am Coll Cardiol 1998; 31 (5; Suppl):318C.