Background: Revascularization with coronary bypass grafting (CABG) has been the gold standard therapy forleft main coronary artery ( LMCA) stenosis. Improvements in angioplasty and coronary stent techniques and equipment warrant a reappraisal of angioplasty in LMCA stenosis. Objectives: To assess in-hospital and six-month clinical outcomes after stenting of unprotected left main coronary artery (LMCA) stenosis. Methodology: Prospective study in a tertiary center of interventional cardiology and cardiac surgery for 64 patients with unprotected LMCA stenosis who were treated with bare-metal stents and underwent angiographic follow-up at 3 and months following the intervention. Results: The procedural success rate was 100% with no episodes of acute or subacute stent thrombosis. in-stent restenosis rate was 15.6% and 15.9% in the first 3 and 6 months respectively. Six month mortality was nil. Conclusion: Stenting of unprotected LMCA stenosis deserves to be considered a safe and effective alternative to CABG in carefully selected patients Recommendation: Larger series should clarify whether unprotected LMCA stenting has the same favorable results as CABG .

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Background: Clopidogrel is an antiplatelet therapy that is widely used in pre and post percutaneous (PCI) coronary intervention procedures to prevent platelet aggregation and stent restenosis. However, there is a wide interindividual variation in clopidogrel response and some patients showed resistance against the activity of Clopidogrel. Kinase insert domain receptor (KDR) gene is responsible for the transcription of vascular endothelial growth factor receptor 2 (VEGFR2) that plays a major role in the cardiovascular diseases (CVDs) and platelet aggregation. The aim of this study was to find out the association of KDR rs1870377 genotype with clopidogrel resistance (CR) in CVD patients, of Iraqi Arabic origin, hospitalized for elective PCI. Materials and methods: This study was a case-control study with a total of 324 PCI patients. Those patients were classified into 213 patients with non-clopidogrel resistant and 111 patients with CR, depending on the analysis of platelet activity phenotype after clopidogrel administration. KDR rs1870377 was genotyped for all patients using polymerase chain reaction-restriction fragment length polymorphism technique and confirmed by DNA S€ anger sequencing through applying Biosystems Model (ABI3730x1). Results: KDR rs1870377 SNP is strongly associated (Chi-sqaure, p vale <0.05) with CR under dominant, codominant and recessive models. Additionally, A allele in the rs1870377 SNP may have an impact on the serum levels of VEGFR2 and low density lipoprotein. Conclusions: KDR rs1870377 SNP is a potential genetic biomarker of CR among CVD patients of Iraqi Arabic origin. Further clinical studies, with larger sample, are required to confirm the findings of this study.

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