Prevalence of left main coronary artery disease among patients referred to multislice computed tomography coronary examinations

Gemici, Gökmen; Güneysu, Tahsin; Eroğlu, Elif; Bayrak, Fatih; Sevinc, Deniz; Aytaclar, Semih; Kaya, Zafer; Mutlu, Bülent; Değertekin, Muzaffer

doi:10.1007/s10554-008-9380-7

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Despite the fact that significant left main disease (LMD) is a rather uncommon finding in patients with stable [ 1 ] or unstable [ 2 ] coronary artery disease (CAD), a significant narrowing of the LM is related to a potentially large area of ischemia leading to high-risk adverse cardiac events. The traditional approach for the management of LMD includes coronary artery bypass grafting (CABG), particularly if additional risk factors of an unfavorable outcome of percutaneous coronary intervention (PCI) occur.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Orbital Atherectomy and Rotational Atherectomy in Calcified Left Main Disease: Short-Term Outcomes

Rola

Kulczycki²,

Barycki

et al. 2023

JCM

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Background: Coronary calcifications, particularly in left main disease (LMD), are independently associated with adverse outcomes of percutaneous coronary intervention (PCI). Adequate lesion preparation is pivotal to achieve favorable short- and long-term outcomes. Rotational atherectomy devices have been used in contemporary practice to obtain adequate preparation of the calcified lesions. Recently, novel orbital atherectomy (OA) devices have been introduced to clinical practice to facilitate the preparation of the lesion. The objective of this study is to compare the short-term safety and efficacy of orbital and rotational atherectomy for LMD. Methods: we retrospectively evaluated a total of 55 consecutive patients who underwent the LM PCI supported by either OA or RA. Results: The OA group consisted of 25 patients with a median SYNTAX Score of 28 (26–36). The Rota group consisted of 30 patients with a median SYNTAX Score of 28 (26–33.1) There were no statistical differences in MACCE between the RA and OA subpopulations when recorded in-hospital (6.7% vs. 10.3% p = 0.619) as well as in a 1-month follow-up after the procedure (12% vs. 16.6% p = 0.261). Conclusion: OA and RA seem to be similarly safe and effective strategies for preparating the lesion in the high-risk population with calcified LMD.

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Section: Introductionmentioning

confidence: 99%

Comparison of Orbital Atherectomy and Rotational Atherectomy in Calcified Left Main Disease: Short-Term Outcomes

Rola

Kulczycki²,

Barycki

et al. 2023

JCM

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“…In the present issue of the International Journal of Cardiovascular Imaging Gemici et al [37] evaluated the prevalence of left main disease in 1,000 patients referred to MSCT (64-slice) coronary angiography. Left main coronary artery was classified into three groups: (1) normal left main coronary artery, (2) nonsignificant left main disease with coronary plaques resulting in \50% luminal stenosis, and (3) significant left main disease corresponding to [50% luminal stenosis.…”

mentioning

confidence: 99%

“…In that particular study, Pundziute et al [24] showed an 8% one-year event rate for patients with nonobstructive CAD versus 0% for patients without any signs of CAD. The study by Gemici et al [37] adds therefore important information to the capability of MSCT in assessing local plaque burden in patients with left main disease, in particular in those patients with non-significant left main disease. Timely detection of atherosclerosis of the left main coronary artery will therefore become a major challenge.…”

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confidence: 99%

Non-significant left main disease; truly non-significant?

Wall

Schuijf

Jukema

et al. 2009

Int J Cardiovasc Imaging

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Amongst the advanced cardiac imaging modalities, multislice computed tomography (MSCT) coronary angiography is emerging as a reliable non-invasive method for the assessment of coronary artery disease (CAD), coronary anatomy and cardiac function [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Improvements in computed tomography technology hold the promise of replacing the standard invasive procedure of conventional coronary angiography in selected patient groups. Multiple studies involving over several thousands of patients have established that MSCT angiography is highly accurate for delineation of the presence and severity of coronary atherosclerosis [18][19][20][21][22][23]. The technique provides independent prognostic information over baseline clinical risk factors in patients with known and suspected CAD [24]. MSCT may also reveal the total plaque burden, i.e., both calcified and non-calcified components, for individual patients with coronary atherosclerosis [25][26][27][28][29][30][31][32]. This holds in particular for detecting patients with left main disease as this disease is associated with a poor prognosis. Timely detection of atherosclerosis of the left main stem is crucial as it may determine future interventional therapy. The standard of care for left main coronary artery disease is coronary artery bypass surgery (CABG), but technical advances in percutaneous coronary intervention (PCI) and stenting technology have emboldened the interventional cardiology community to test the feasibility of and document the procedural results for stenting the left main coronary artery [33][34][35][36]. MSCT may therefore play an important role for guiding interventional therapy by early detection and establishing the severity and extent of coronary atherosclerosis of the left main coronary artery.Rodriquez-Granillo et al.[34] explored the differences in plaque burden at different segments of the left main bifurcation and its relationship with the bifurcation angle using high-resolution MSCT. A total of 50 patients were evaluated using a 40-row MSCT scanner. The localization, severity and distribution of plaques within the left main bifurcation were determined. Seventeen (34%) patients presented wall irregularities in the left main stem and in the ostial left circumflex coronary artery, whereas the ostial left descending coronary artery was affected in 32 (64%) patients. More than 90% of plaques were located opposite to the flow divider. Of the 18 patients with a normal ostial left anterior descending coronary artery, 13 (72%) had a bifurcation angle \88.5°, whereas the 63% of the patients with any disease of left anterior descending coronary artery had an angle C88.5°(P = 0.018). At the left main bifurcation, atherosclerotic plaques were commonly eccentric and located opposite to the flow divider. A Editorial comment to the article of Gemici et al.

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