Drug-Eluting Stents for Left Main Coronary Artery Stenosis: Case Selection and Technical Issues

Park, Seung‐Jung; Park, Duk‐Woo

doi:10.1111/j.1751-7168.2008.07406.x

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…46,52 In patients with very complex anatomic features, which are not feasible for stenting, and concomitant diffuse multivessel disease, CABG is preferred so as to avoid procedural and future thrombotic risks and to provide more complete revascularization. However, in patients with relatively simple LMCA disease, such as ostial/ shaft LMCA disease or isolated LMCA disease (with or without one or 2-vessel involvement), PCI is an alternative, and in some cases a preferred strategy to reduce surgical risks (eg, stroke and in-hospital events following major surgery).…”

Section: Stents Versus Surgerymentioning

confidence: 99%

Percutaneous Coronary Intervention With Stent Implantation Versus Coronary Artery Bypass Surgery for Treatment of Left Main Coronary Artery Disease

Park

2009

Circ: Cardiovascular Interventions

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Abstract-On the basis of clinical trials comparing coronary-artery bypass grafting (CABG) with medical therapy, current guideline recommend CABG as the treatment of choice for patients with asymptomatic ischemia, stable angina, or unstable angina/non-ST elevation myocardial infarction who have left main coronary artery disease. Percutaneous coronary intervention can be selectively performed in patients who are candidates for revascularization but who are ineligible for CABG. However, because of advances in periprocedural and postprocedural medical care in patients undergoing either CABG or percutaneous coronary intervention with stenting, new evaluation, and a review of current indications, may be required to determine the standard of care for patients with left main coronary artery disease. Current evidences indicate that stenting results in mortality and morbidity rates that compared favorably with those seen after CABG, suggesting that a current guideline (the Class III recommendation of percutaneous coronary intervention for unprotected left main coronary artery disease) may no longer be justified. Data from several extensive registries and a large clinical trial may have prompted many interventional cardiologists to select percutaneous coronary intervention with stenting as an alternative revascularization strategy for such patients. In addition, these data may inform future guidelines and support the need for well-designed, adequately powered, prospective, randomized trials comparing the 2 revascularization strategies. The cumulative evidence from ongoing and future clinical trials will change the current clinical practice of revascularization for unprotected left main coronary artery disease, which was introduced several decades ago and which has continued to date without major revision. (Circ Cardiovasc Intervent. 2009;2:59-68.)

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Section: Stents Versus Surgerymentioning

confidence: 99%

Percutaneous Coronary Intervention With Stent Implantation Versus Coronary Artery Bypass Surgery for Treatment of Left Main Coronary Artery Disease

Park

2009

Circ: Cardiovascular Interventions

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“…The choice of PCI or CABG for treatment of unprotected LMCA disease depends on several clinical and anatomic features, making optimal patient selection crucial for appropriate treatment of LMCA disease and achievement of favorable long-term outcomes [27,28]. In patients with very complex anatomic features, which are not feasible for stenting, and concomitant diffuse multivessel disease, CABG is preferred so as to avoid procedural and future thrombotic risks and to provide more complete revascularization.…”

Section: Resultsmentioning

confidence: 99%

Experience of LMCA Angioplasty from a Referral Center and in Hospital Outcomes

Subramanyam

Sireesha

2016

Ind J Car Dis Wom

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Introduction and Objectives: CABG is the treatment of choice for severe left main coronary artery stenosis. The results of a number of multicenter trials have suggested angioplasty with stenting as a possible alternative treatment. Previous studies demonstrated procedural success of 90-100% and Mortality 0.8-2% So, want to see these parameters in Asian population though the LMCA registry of a referral center institute.Material and Methods: We have collected data from patient records who underwent LMCA angioplasty procedure (both unprotected or protected LMCA) performed at our institution between April 2003 to July 2015. Detailed in-hospital data including age, gender, coronary risk factors, procedural events were obtained and analyzed.Results: Angiographically documented success was obtained in 98% patients with zero mortality. In 134 patients the lesions were pre-dilated using a conventional balloon. In 19 patients direct stenting was done. The median diameter and length of the stent was 3.2542 mm and 13.790 mm, respectively. POBA was done in two cases, BMS were used in 27 cases, DES were used in 124 cases.Only LMCA stenting was done in 53 cases LMCA with other vessels stenting was done in 98 cases. FFR was used in 2 cases, Kissing balloon dilatation was used in 8 cases, ostial flaring was done in 5 cases. There was no mortality in the study but on table stent thrombosis was seen in one patient for which thrombuster was used, IABP was placed immediately and sent for CABG. For one case result was suboptimal.Conclusions: Present study demonstrated that stenting for significant LMCA disease is safe and feasible with very high procedural and clinical success rates and zero mortality. LMCA-left main coronary artery, POBA-plain old balloon angioplasty, PCI-Percutaneous coronary intervention, CABG-coronary artery bypass grafting, FFR-Fractional flow reserve, TIMI- thrombolysis in myocardial infarction, DES-drug eluting stent, BMS-bare metal stent, TLR-Target lesion revascularization.

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“…The choice of PCI or CABG for treatment of unprotected LMCA disease depends on several clinical and anatomical features, making optimal patient selection crucial for appropriate treatment of LMCA disease and achievement of favorable long-term outcomes 18,24. In patients with very complex anatomical features, which are not feasible for stenting and concomitant diffuse multivessel disease, CABG is preferred so as to avoid procedural and future thrombotic risks and to provide more complete revascularization.…”

Section: Stents Versus Surgerymentioning

confidence: 99%

Stenting versus Bypass Surgery for the Treatment of Left Main Coronary Artery Disease

Park

2009

Yonsei Med J

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Based on data comparing coronary-artery bypass grafting (CABG) with medical therapy, the current guidelines recommend CABG as the treatment of choice for patients with left main coronary artery (LMCA) disease. Percutaneous coronary intervention (PCI) can be selectively performed in patients who are candidates for revascularization but who are ineligible for CABG. Current evidence indicates that stenting results in mortality and morbidity rates compared favorably with those seen after CABG. Data from several extensive registries and a large clinical trial may have prompted many interventional cardiologists to choose PCI with stenting as an alternative treatment option for such patients. In addition, these data may inform future guidelines and support the need for well-designed, adequately powered, prospective, randomized trials comparing the two revascularization strategies.

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Drug-Eluting Stents for Left Main Coronary Artery Stenosis: Case Selection and Technical Issues

Cited by 3 publications

References 33 publications

Percutaneous Coronary Intervention With Stent Implantation Versus Coronary Artery Bypass Surgery for Treatment of Left Main Coronary Artery Disease

Percutaneous Coronary Intervention With Stent Implantation Versus Coronary Artery Bypass Surgery for Treatment of Left Main Coronary Artery Disease

Experience of LMCA Angioplasty from a Referral Center and in Hospital Outcomes

Stenting versus Bypass Surgery for the Treatment of Left Main Coronary Artery Disease

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