Percutaneous transluminal coronary angioplasty of the left main coronary artery in patients with rest angina

Abstract

Left main coronary angioplasty may be a therapeutic revascularization procedure for a subset of patients with symptomatic coronary artery disease. The purpose of this study is to report procedural outcomes and long-term clinical follow-up of 15 patients who underwent either protected or unprotected left main angioplasty for rest angina. These patients represent a cohort of unstable angina patients who were considered high risk for coronary artery bypass surgery. Ten of 15 patients had Canadian Heart Class IV angina, and three patients were hemodynamically unstable. Balloon angioplasty was successful in 4 patients, and one patient was treated with directional atherectomy. Initial angiographic success was achieved in 14 of 15 patients (93%). Major complications (myocardial infarction, emergent coronary artery bypass graft, death) occurred in one patient (6%); 73% of the patients were asymptomatic or had stable exertional angina at 6 months follow-up. One year survival was 87% (13 of 15). During the follow-up period six patients had repeat catheterization for recurrent angina. Four of these patients had left main restenosis and underwent successful repeat left main angioplasty. No patient had coronary bypass surgery during follow-up. This report suggests that left main angioplasty can be a safe and effective revascularization procedure for critically ill patients with unstable angina who are at high risk for coronary bypass surgery.

Left main intervention revisited: Early and late outcome of PTCA and stenting

“…Angiographic follow-up was available in only 10 patients, and 5 (50%) had a significant LMCA restenosis requiring repeat PTCA. This high incidence of restenosis is consistent with previous reports [14,26,27]. There is little experience with LMCA stenting, and further experience and refinement of stent design may allow broader application in LMCA intervention.…”

Comparison of quantitative coronary angiographic results after directional coronary atherectomy and balloon angioplasty of protected left main coronary stenosis

“…However, the overall success of simple balloon angioplasty is limited by the high clinical restenosis rate [1][2][3][4][5]. Directional coronary atherectomy seems to be a better treatment for left main stenosis than balloon angioplasty, because the diseased arteries often include an ostial lesion or have the characteristics of a bulky and eccentric lesion.…”

“…In selected patients, however, percutaneous transluminal coronary angioplasty has become accepted as an alternative to coronary bypass surgery. Balloon angioplasty of left main coronary stenosis can be performed safely with a high procedural success rate in patients with one or more patent grafts to the left coronary system [1][2][3][4][5]. However, balloon angioplasty of protected left main coronary stenosis is limited by the high rate of restenosis and is associated with a poor long-term result.…”

Short‐ and long‐term results of emergency and elective percutaneous interventions on left main coronary artery stenoses

“…After the first reports on successful percutaneous LM interventions, a number of angiographic centers evaluated and published their experience concerning the immediate and late outcomes of LM PTCA in patients without contraindications to CABG. Their conclusion was that elective percutaneous interventions to treat protected and even unprotected LM stenoses can be a safe and effective therapeutic choice [6–14]. Consequently, the most recent editions of the American Heart Association Guidelines related to the treatment of stable and unstable angina pectoris no longer regarded LM stenosis as an absolute contraindication to a percutaneous intervention [15, 16].…”