Single-stent crossover technique from distal unprotected left main coronary artery to the left circumflex artery

Abstract

Objectives: To report the clinical outcomes of single-stenting from distal unprotected left main coronary artery (LMCA) to the left circumflex artery (LCx). Background: Percutaneous coronary intervention of distal LMCA is usually performed by stenting into the left anterior descending artery (LAD). In some cases, stenting from LMCA to LCx alone is performed. Methods: Between April 2002 and April 2011, single-stenting with drug-eluting stent for distal unprotected LMCA disease was performed in 584 patients. Thirty-one patients underwent LMCA-LCx stenting, who were compared with the remaining 553 LMCA-LAD stented patients. Results: At 3-year follow-up, there were no significant differences between LMCA-LCx and LMCA-LAD stenting groups in major adverse cardiac events (24.1% vs. 19.6%, p=0.540), cardiac death and myocardial infarction. A trend towards higher target lesion revascularization (TLR) in the LMCA-LCx stenting group was noted. This was significant when the stented-branch was only considered (18.2% vs. 3.0%, p<0.001). In both TLR-subgroups, LCx-ostium was frequently involved (83.3% in LMCA-LCx vs. 66.2% in LMCA-LAD TLR-subgroups, p=0.39). The LAD-ostium was more frequently involved in LMCA-LCx TLR-subgroup (83.3% vs. 21.0%, p<0.001). On the multivariable Cox regression analysis, LMCA-LCx stenting was an independent predictor of TLR for restenosis at the ostium of the stented-branch (HR 6.49, 95% CI 2.27-18.53, p<0.001). Conclusions: TLR rate at the LCx-ostium is high irrespective of LMCA-LCx or LMCA-LAD stenting. The former also seems to be associated with high TLR at the LAD-ostium. It may therefore be important to evaluate alternative strategies for treating distal LMCA disease that extends into the LCx but not LAD.