Management of Left Main Coronary Artery Disease

Ramadan, Ronnie; Boden, William E.; Kinlay, Scott

doi:10.1161/jaha.117.008151

Cited by 78 publications

(65 citation statements)

References 63 publications

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“…LMCA disease can involve either the ostium or the main vessel or its bifurcation; the left main stem supplies with blood most of the myocardium, and thus, treatment failure can lead to critical peri-procedural complications during PCI (126)(127)(128)(129). In the EXCEL trial, PCI was non-inferior to CABG in terms of the primary endpoint (all-cause death, stroke, or MI) at 3 years (HR: 1.00, 95% CI 0.79-1.26) (128) and at 5 years (HR: 1.19, 95% CI 0.95-1.50) (130) in patients with LMCA disease and low or intermediate SYNTAX scores.…”

Section: Hybrid Ivus-oct Catheter For Left Main Coronary Artery Diseasementioning

confidence: 99%

Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging

Ono

Kawashima

Hara

et al. 2020

Front. Cardiovasc. Med.

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Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been developed and improved as both diagnostic and guidance tools for interventional procedures over the past three decades. IVUS has a resolution of 100 µm with a high tissue penetration and capability of assessing the entire structure of a coronary artery including the external elastic membrane, whereas OCT has a higher resolution of 10-20 µm to assess endoluminal structures with a limited tissue penetration compared to IVUS. Recently, two companies, CONAVI and TERUMO, integrated IVUS and OCT into a single catheter system. With their inherent strength and limitations, the combined IVUS and OCT probes are complementary and work synergistically to enable a comprehensive depiction of coronary artery. In this review, we summarize the performance of the two intracoronary imaging modalities-IVUS and OCT-and discuss the expected potential of the novel hybrid IVUS-OCT catheter system in the clinical field.

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Section: Hybrid Ivus-oct Catheter For Left Main Coronary Artery Diseasementioning

confidence: 99%

Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging

Ono

Kawashima

Hara

et al. 2020

Front. Cardiovasc. Med.

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“…Due to significant advances in device technology, increased operators´ expertise, and availability of improved antithrombotic therapy, PCI in left main coronary artery disease has emerged as a valid alternative technique to operative coronary artery bypass grafting [2,[8][9][10]. Current European and American guidelines recommend both CABG and PCI for treatment of LMD with overall less complex anatomy [3,11].…”

Section: Discussionmentioning

confidence: 99%

One-year clinical and angiographic outcomes after percutaneous coronary interventions in ostial versus distal left main lesions – a retrospective single center study

Stephan¹,

Goldberger²,

Keßler³

et al. 2019

Preprint

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Background: Percutaneous coronary intervention (PCI) of left main coronary artery disease (LMD) is associated with appropriate clinical and angiographic outcomes, resulting in a class I recommendation in patients with less complex coronary anatomy. Due to higher SYNTAX scores and worse clinical outcomes, PCI in distal LMD is accomplished with a lower strength of recommendations for revascularization compared to ostial LM lesions. We compare angiographic and clinical outcomes of ostial/midshaft lesions versus distal lesion in LMD after PCI. Methods: This retrospective study included 176 patients with LMD undergoing PCI with drug-eluting stents. The study population was divided into 34 patients with ostial/midshaft LMD and 142 patients with distal LMD. Patients were routinely scheduled for 9 months of angiographic and 12 months of clinical follow-up. Quantitative coronary analysis (QCA) was performed for all lesions, using an 11-segment model. Primary outcome was MACE (major adverse cardiac events) defined as a composite of cardiac death, myocardial infarction and target lesion revascularization (TLR). Results: The primary outcome measure was comparable in both cohorts after 12 months follow-up (20.6% in ostial/midshaft LMD vs. 17.6% in distal LMD, P=0.71). As expected, TLR rates were increased in distal LM lesions compared to ostial LM lesions, but without reaching statistical significance (14.1% vs. 5.9%, P=0.15). Late lumen loss (LLL) in ostial/midshaft LMD was 0.42±0.33mm. In distal LM lesions value for LLL in the main vessel was 0.42±0.97 mm, with the highest values observed in segments adjacent to the bifurcation (0.37±1.13mm and 0.37±0.73 mm). On cox proportional regression analysis LLL in a bifurcation segment (P=0.03, HR 1.68 [1.1-2.7]) and diabetes mellitus (P=0.046, HR 2.77 [1.0-7.5] were independent correlates for occurrence of MACE. Conclusion: PCI of distal LM lesions result in comparable angiographic and clinical outcomes compared to ostial LM lesions. Highest rates for binary restenosis were observed in segments nearest to the bifurcation.

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“…LIMA bypass graft during CABG surgery is a surgical standard [ 5 , 6 ]. It was originally thought that CSSS is a relatively uncommon phenomenon following CABG, with a reported incidence of between 0.2 and 6.8%, it is now thought that this is an under-estimate of the true clinical magnitude of the problem [ 2 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Coronary subclavian steal syndrome—is there a need for routine assessment for subclavian artery stenosis following coronary bypass surgery?

Waduud

Giannoudi

Drozd

et al. 2018

Oxford Medical Case Reports

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Subclavian artery stenosis (SAS) resulting in coronary subclavian steal syndrome (CSSS) is a common but under recognized pathology following coronary artery bypass surgery (CABG). Patients with SAS may be asymptomatic due to the sub-clinical diversion of blood flow from the myocardium and retrograde blood flow during catheter angiography in the left internal mammary artery (LIMA) may be the first suggestion of CSSS. The management of SAS, causing CSSS, may rarely require acute assessment and intervention. However, full anatomical assessment of the stenosis morphology may be limited on fluoroscopy. Correction of SAS may be essential to achieve effective reperfusion therapy.

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Management of Left Main Coronary Artery Disease

Cited by 78 publications

References 63 publications

Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging

Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging

One-year clinical and angiographic outcomes after percutaneous coronary interventions in ostial versus distal left main lesions – a retrospective single center study

Coronary subclavian steal syndrome—is there a need for routine assessment for subclavian artery stenosis following coronary bypass surgery?

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