Serial Angiographic Follow-Up of Sirolimus-Eluting Stents for Unprotected Left Main Coronary Artery Revascularization

Price, Matthew J.; Cristea, Ecaterina; Sawhney, Neil; Kao, John; Moses, Jeffrey W.; Leon, Martin B.; Costa, Ricardo; Lansky, Alexandra J.; Teirstein, Paul S.

doi:10.1016/j.jacc.2005.12.015

Cited by 189 publications

(147 citation statements)

References 21 publications

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“…[4][5][6][7][8][9][10]15 In our study isolated LMS did not occur, but LMS was associated with non-critical CAD in 8 patients (7.8%). So, our results were similar to international studies regarding involvement of LMS with multivessel CAD and predominance of distal vessel involvement.…”

Section: Discussioncontrasting

confidence: 39%

“…[3][4][5][6][7][8][9][10] In our study location of the lesion was distal in 70 (68.6%) patients.In a study by Saeed Sadeghian et al showed that the proportion of the male sex in those with LMS was higher than that of the ones without LMS stenosis (87.8% vs. 71.4%, P=0.020) and that patients with LMS stenosis were older (mean age of 58.8±10.5 years in those with LMS stenosis vs. 55.6±9.2 in the ones without LMS, P=0.03).…”

Section: Discussionmentioning

confidence: 43%

“…LMS stenosis currently occurs in 4% to 6% of all patients undergoing coronary angiography (CAG) 1 and in 30% of coronary artery bypass grafting (CABG) 2 patients. LMS stenosis occurs as an isolated lesion in 6% to 9% of patients, whereas over 70% to 80% ofpatients also have multi vessel coronary artery disease (CAD) [3][4][5][6][7][8][9][10] .As, LMS stenosis has high risk of restenosis.11 So, traditionally, CABG is the treatment of LMS coronary artery stenosis. However, drawbacks include multiple vascular anastomoses (which consume bypass conduits and can lead to complications), permanent occlusion of the LMS coronary artery, 1 and less physiologic retrograde myocardial perfusion.…”

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confidence: 99%

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Pattern of left main stenosis at a tertiary cardiac center of Nepal

et al. 2017

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INTRODUCTIONLeft main coronary artery is the most important coronary artery since it is responsible for blood supply to more than two thirds of the heart muscle. A significant left main stem (LMS) stenosis is considered to be a lesion occupying over 50% of the vessel diameter. LMS stenosis currently occurs in 4% to 6% of all patients undergoing coronary angiography (CAG) 1 and in 30% of coronary artery bypass grafting (CABG) 2 patients. LMS stenosis occurs as an isolated lesion in 6% to 9% of patients, whereas over 70% to 80% ofpatients also have multi vessel coronary artery disease (CAD) [3][4][5][6][7][8][9][10] .As, LMS stenosis has high risk of restenosis.11 So, traditionally, CABG is the treatment of LMS coronary artery stenosis. However, drawbacks include multiple vascular anastomoses (which consume bypass conduits and can lead to complications), permanent occlusion of the LMS coronary artery, 1 and less physiologic retrograde myocardial perfusion. 12Looking at the severity of the disease and difficulties in treatment, in this study, we aim to study pattern of LMS stenosis in cardiology department of a tertiary cardiac center in Nepal. METHODThis was a retro prospective study single center. This study was conducted from the properly maintained record of 2 years (August 2011to July 2013) of cardiac catheterization labs of tertiary cardiac center, Shahid Gangalal National Heart Center. Records from all the patients undergoing CAGs were collected. Most trials of treatment and treatment guidelines define significant LMS stenosis as a greater than 50% diameter stenosis as judged by contrast angiography.13 Same diagnostic criteria were used in our study. Study was approved by the institution review committee of the national heart centre. All data was analyzed using SPSS 16.0. RESULTSDuring the study period 3290 coronary angiogram were done. Among them, 952 (28.9%) had normal coronary artery, 401 (12.1%) had non-critical CAD, 842 (25.5%) had single vessel disease (SVD), 557 (16.9%) had double vessel disease (DVD), 436 (13.2%) had triple vessel disease (TVD) and 102 (3.1%) patients had LMS stenosis.Among the 102 patients with LMS stenosis mean age of patients was 60.6±10.1 years. Seventy Five (73.5%) patients were of age more than 55 years. Most 82 (80.3%) of them were male. Fifty three (51.9%) were hypertensive, 47 (46.0%) were diabetic. Chronic stable angina was the main reason for coronary angiogram in LMS stenosis patients as shown in table 1. Original Article -AuditDepartment of Cardiology, Shahid Gangalal National Heart Center, Bansbari, Kathmandu, Nepal Corresponding author: Binay Kumar Rauniyar Department of Cardiology, Shahid Gangalal National Heart Center, Bansbari, Kathmandu, Nepal, Email Address: brauniyar@hotmail.com Abstract Background and Aims: Left main stem stenosis is defined as a lesion occupying more than 50% of the lumen diameter. Various studies have shown that left main stem stenosis occurs in 4%-6% of all the patients undergoing coronary angiography. We aim to find out the pattern of Left...

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Section: Discussioncontrasting

confidence: 39%

Section: Discussionmentioning

confidence: 43%

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confidence: 99%

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Pattern of left main stenosis at a tertiary cardiac center of Nepal

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“…Apart from being technically challenging with the use of two stents, the long-term outcome have also been reported to be less favourable, and inconsistent. [10][11][12] Target lesion revascularisation (TLR) and target vessel revascularisation (TVR) ranged from 2% to 38% and cardiac mortality from 0% to 11%. 10 A single centre retrospective observational study reported 5% incidence of in-hospital complication with use of DES in unprotected LMCA disease.…”

Section: Discussionmentioning

confidence: 99%

Left main coronary artery bifurcation angioplasty and stenting after aortic valve replacement: a case report

Roy

Bana

Gupta

et al. 2012

Indian Heart Journal

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“…However, the story has been different for bifurcation lesions with several studies showing LMCA distal bifurcation lesions as unfavorable settings for percutaneous intervention due to lower procedural success and higher restenosis rates. 15 -17 To site 1 example, Price et al 18 published data on 50 patients with 94% of distal bifurcation lesions and 9 months follow-up; MACE rate was 10% in-hospital and 44% at 9 months with an overall angiographic restenosis rate of 42%.…”

Section: Discussionmentioning

confidence: 99%

Two‐Year Outcomes of the Sirolimus‐Eluting Stent According to Unprotected Left Main Lesion

Kim

Park

Seol

et al. 2009

Clinical Cardiology

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Background: The data of long-term outcomes of sirolimus-eluting stent (SES) according to lesion location of unprotected left main coronary artery (LMCA) is scarce. Hypothesis: The purpose of this study was to evaluate the long-term outcomes after implantation of the SES in LMCA. Methods: A total of 84 patients (51 males) who had undergone SES implantation for the treatment of native LMCA stenosis were enrolled. The patients were divided into 2 groups based on angiographic lesion location: those with significant stenosis in the ostium and/or body (group 1; n = 39) and those involving bifurcation (group 2; n = 45). Results: All of the group 1 patients were treated with simple lesion coverage while different stenting techniques were used in group 2 (cross-over: 44.8%, T: 6.7%, kissing: 37.8%, and crush techniques: 11.1%). The 8-month quantitative angiographic findings and in-hospital and 2 year rates of major adverse cardiac events (MACE) were compared between the 2 groups. Although angiographic success and in-hospital MACE rates were similar in both groups with 1 cardiac death due to acute stent thrombosis in group 2, at 2-year follow-up, the MACE rate was significantly higher in group 2 than in group 1 at 2 years (22.2% vs 2.6%, respectively, P = 0.008). Coronary angiography revealed a significantly higher binary restenosis rate in group 2 compared with group 1 (20% vs 0%, respectively, P = 0.003). Conclusions: Interventional treatment using SES in left main lesions showed favorable short-term and longterm outcomes in selected patients with lesion location being an important determinant of clinical and angiographic outcomes. IntroductionPercutaneous coronary intervention (PCI) with drug-eluting stent (DES) has been associated with marked reductions in restenosis rates 1 and neointimal hyperplasia formation; 2 this also appears to be the case for the treatment of unprotected left main coronary artery (LMCA) lesions, 3 -5 an observation that stands in contrast with the fact that in the bare-metal stent era an LMCA lesion was a definite indication for coronary artery bypass graft (CABG) surgery. However, there is little data on the long-term outcomes according to LMCA lesion complexity and location and therefore this registry study was aimed at evaluating long-term clinical and angiographic outcomes according to LMCA lesion location post sirolimus-eluting stent (SES) implantation.

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Serial Angiographic Follow-Up of Sirolimus-Eluting Stents for Unprotected Left Main Coronary Artery Revascularization

Abstract: Restenosis is a frequent finding when serial angiographic follow-up is performed after SES implantation for unprotected distal LMCA lesions. Restenosis is usually focal, most often involves the LCX ostium, and often occurs without symptoms.

Cited by 189 publications

References 21 publications

Pattern of left main stenosis at a tertiary cardiac center of Nepal

Pattern of left main stenosis at a tertiary cardiac center of Nepal

Left main coronary artery bifurcation angioplasty and stenting after aortic valve replacement: a case report

Two‐Year Outcomes of the Sirolimus‐Eluting Stent According to Unprotected Left Main Lesion

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