Abstract
The left main coronary artery (LMCA) is responsible for supplying about 75% to 100% of the left ventricular cardiac mass. Left main stem coronary artery (LMCA) disease reduces flow to a large portion of the myocardium, placing the patient at high risk for life-threatening events such as left ventricular dysfunction and arrhythmias with a high mortality approaching 50% in those treated medically. For several decades, coronary artery bypass grafting (CABG) has been considered as a gold standard treatment of unprotected left main coronary artery (ULMCA). However, successful percutaneous coronary interventions (PCI) have been increasingly reported recently due to improved stent technology and better operator expertise. In spite of these factors, management can be challenging especially in LMCA bifurcational & trifurcational lesions, and therefore an integrated approach combining special techniques, physiological evaluation and adjunctive pharmacological agents should be combined for better clinical outcome. Herein, we describe a new promising technique named (Kurdistan technique) for the treatment of trifurcation unprotected left main stem lesion. In the last 18 months, 21 patients with significant trifurcational LMS had underwent PCI using this technique in our hospital (Sulaimany Heart Hospital/Kurdistan). The procedural success rate was 100%, follow up coronary angiography done between 6 - 12 months after the procedure for all the patients with no significant in-stent restenosis in any patient. One case is presented here demonstrating the technique.
Highlights
Significant unprotected left main coronary artery disease (LMCA) occurs in 5% - 10% of patients undergoing coronary angiography [1] [2]
Serruys reported that revascularization with percutaneous coronary interventions (PCI) has comparable safety and efficacy outcomes to coronary artery bypass grafting (CABG) for patients with LMCA disease [3]
Choice of strategy is based on vessel and lesion characteristics and on operator’s experience
Summary
Significant unprotected left main coronary artery disease (LMCA) occurs in 5% - 10% of patients undergoing coronary angiography [1] [2]. For risk stratification for procedural and long-term outcomes combination of SYNTAX and the Euro SCORE into a common risk model (Global Risk Classification) was correlated with a significant improvement in predicting cardiac mortality in patients undergoing PCI for LMCA [17]. Another score, the New Risk Stratification Score showed a higher sensitivity and specificity to predict clinical outcome [18]. Angiography demonstrated diseased distal left main stem( LMS) with about 40% - 50% stenosis, critical ostial & proximal LAD lesion, significant ostial left circumflex (LtCx) & 95% ostial ramus intermedius lesion, the LMS was 4.1 mm in diameter & proximal LAD was 3.8 mm (Figure 1(a) & Figure 1(b)). Angiography done shows dissection in the ostium of ramus intermedius (Figure 6) & proven by IVUS (Figure 7)
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