Left Main Stem Coronary Artery Research Articles

Effectiveness of using dual stent to intervene true left main coronary artery bifurcation lesions

Abstract: Lesions at the bifurcation of the left main coronary artery are dangerous lesions that account for approximately 4–8% of CAD (coronary artery disease) cases. In Vietnam, dual stent percutaneous coronary intervention has been used to treat true left main stem coronary artery bifurcation lesions, but there is no study that summarizes the recent results and evaluates them after a follow-up period. Consequently, we conducted this study.
 Research objectives: Effectiveness of using dual stent to intervene true left main coronary artery bifurcation lesions.[1]
 Objects and research methods: Crossectional study, review of all patients who received LMCA bifurcation lesions interventional stenting with dual stent at Hanoi Heart Hospital from 1/2018 to 6/2020.
 Research results: The rate of major cardiovascular events was determined as follow: 1 patient died during hospital stay; 18% of patients had at least one major cardiovascular event during the 12-month follow-up period; 3 patients had cerebrovascular accidents, which accounted for 6%; 3 patients had acute myocardial infarction, which accounted for 6%; and 2 patients had acute myocardial infarction, which accounted for 6%. Two patients require revascularization, representing 4% of the total population.

Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery

Introduction. The left main stem (MS) coronary artery (CA) (MSCA) thrombosis is a rare but potentially lethal manifestation of acute coronary syndrome. The standard approach in treating such patients is the primary percutaneous coronary intervention (pPCI) or CA bypass graft surgery. In some cases, depending on the morphological appearance of the thrombus, findings and flow rates assessed on coronary angiography (CAn), clinical conditions, and cardiologist?s experiences, another possible method of treatment can be the conservative approach using antithrombotic therapy. Case report. A 37-year-old male was admitted to the emergency room with symptoms of an acute myocardial infarction with an ST elevation in diaphragmal localization. Using an emergency CAn, we have visualized a thrombus at the ostial and proximal part of the left MSCA, with no complete obstruction of the blood flow. Initially, dual antithrombotic therapy (ticagrelor and acetylsalicylic acid) was applied, and in the further procedure, it was decided to introduce glycoprotein IIb/IIIa platelet receptor inhibitor (tirofiban) as an intracoronary bolus (0.3 ?g/kg) and later as a continuous infusion (0.1 ?g/kg/min). Four days later, a control CAn and intravascular echocardiography were performed, and it was decided to continue the treatment using conservative therapy without a pPCI procedure. The patient was discharged in good condition with no signs of illness on the eighth day after hospital admission for home recovery, with planned frequent follow-ups in the future. Conclusion. In the case of non-obstructive thrombotic masses without significant atherosclerotic stenotic lesions, conservative treatment modality with the use of aggressive antithrombotic therapy may be considered.

IVUS determination of normal left main stem artery size and plaque burden, and correlation with body surface area in an Indian population.

There is a scarcity of data regarding the normal size of the left main stem coronary artery (LMS) in the Indian population; further data are needed to help determine the optimal device size during percutaneous coronary intervention (PCI). The aim of our study was to determine the normal size of the LMS and to calculate the mean plaque burden (PB) in the left main arteries which are angiographically normal or insignificantly diseased, using intravascular ultrasound (IVUS). We hoped to establish a correlation between LMS size and body surface area (BSA). We collected demographic and coronary artery data from 140 patients who underwent IVUS-guided PCI in the left anterior descending and circumflex arteries over a 2-year period from 2019 to 2020, where a pullback sequence of the LMS was available. The reference and luminal vessel diameters, the reference and luminal vessel areas and the mean plaque burden (PB) were obtained. Regression analysis was used to develop a correlation between BSA and LMS diameter. The IVUS-determined mean reference diameter of the LMS was 5.53±0.63 mm and the mean luminal diameter was 4.62±0.65 mm. The mean reference vessel area was 24.79±5.5 mm2 and the luminal vessel area was 17.19±4.89 mm2. The mean PB was found to be 29.21% in patients with an angiographically normal left main and 32.29% in patients with angiographically insignificant left main stenosis. A linear correlation was noted between the left main reference and luminal vessel diameters; the correlation equations derived were 3.57+1.01 BSA and 2.95+0.87 BSA, respectively. The mean reference and luminal diameters of LMS in the Indian population are on par with the size of LMS in other ethnicities. The vessel compensates for up to 40% PB with vessel remodelling. Hence, a PB of 40% is a good landing zone for stent deployment.

ASSOCIATION OF ST ELEVATION IN LEAD AVR WITH LEFT MAIN STEM AND TRIPLE VESSEL DISEASES IN PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION

Objectives: To determine frequency of left main stem (LMS) and triple vessel coronary artery disease (3VCAD) in patients of Non-ST-elevation myocardial infarction (NSTEMI) and to compare the frequency of LMS and 3VCAD in patients with NSTEMI with or without ST elevation in lead aVR. Methodology: Total 346 patients with NSTEMI having age 30-70 years were included in this descriptive cross-sectional study. The data on demographic details was collected. All patients underwent electrocardiography (ECG) and cardiac specific troponin-I assessment. Patients were categorized as NSTEMI with or without ST-elevation in lead aVR. Coronary angiography was performed in all patients and angiographic findings were noted. Results: Mean age of patients was 51.87±10.03 years. There were 218 (63.01%) males and 128 (36.99%) female patients. 182 (52.60%) patients of NSTEMI had ST elevation in aVR. LMS disease was found in 53 (29.10%) patients with ST elevation in aVR. Sensitivity, specificity, positive predive value and negative predictive value of ST elevation in aVR for LMS disease was 62.35%, 50.57%, 29.12% and 80.49% respectively. 3 VCAD was found in 54 (29.70%) with ST elevation in aVR. Sensitivity, specificity, positive predive value and negative predictive value of ST elevation in aVR for 3VCAD was 77.14%, 53.52%, 29.67% and 90.24% respectively. Conclusion: NSTEMI patients with ST elevation in aVR may have higher chances of having LMS disease or 3VCAD. There is high negative predictive value for ST elevation in aVR to predict LMS disease or 3VCAD.

The Most Relevant Factors Affecting the Perioperative Death Rate in Patients with Acute Coronary Syndrome and COVID-19, Based on Annual Follow-Up in the ORPKI Registry.

Background: The COVID-19 pandemic is significantly affecting the functioning of the entire healthcare system. The disease itself may be associated with thromboembolic complications. The purpose of this study is to compare patients with acute coronary syndrome (ACS) and patients with ACS who were diagnosed with COVID-19 in terms of their clinical profile, management, treatment complications, and prognosis. Methods: We analyzed 47,940 cases of patients treated for ACS in 2020, including 44,952 patients (93.8%) who were not diagnosed with COVID-19 and 2988 patients (6.2%) who tested positive for COVID-19. Results: Patients with COVID-19 were significantly more likely to experience out-of-hospital sudden cardiac arrest (7.9 vs. 1.1%; p < 0.0001) and be transported directly to a catheterization laboratory (21.3% vs. 8.1%; p < 0.0001). Mortality was significantly higher in this group (0.9% vs. 0.4%; p < 0.0001). The risk of perioperative death was increased by age over 65 years, use of glycoprotein IIb/IIIa inhibitors (GPI IIb/IIIa), femoral access, critical left main stem coronary artery (LMCA) vascular lesions, ST elevation myocardial infarction (STEMI), and no-reflow phenomenon. Conclusions: Despite the pandemic, patients with COVID-19 were treated equally to healthy patients. Efficient organization of the healthcare system allowed the prompt transportation of patients to catheterization laboratories. The study group was characterized by a worse prognosis that was affected by multiple factors.

Frequency of significant carotid artery disease on carotid angiography in patients with left main stem coronary artery disease.

Objectives: To determine the frequency of significant carotid artery disease on carotid angiography in patients presenting with left main stem coronary artery disease. Study Design: Cross Sectional study. Setting: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: October 2016 to April 2017. Material &amp; Methods: 140 patients were included in this study. To diagnose carotid artery disease, carotid angiography was performed. Imaging was performed while subjects were lying in a supine position. Arterial access gained through femoral artery and using Headhunter carotid angiography catheter (6F). Lateral, AP and ipsilateral oblique views was obtained. Results: Age ranges between 40-75 years with mean age of 53.91±7.05 years. There were 94 (67.2%) male patients while remaining 46 patients (32.8%) were female. Carotid artery disease was found in 54 patients (38.6%). Stratification with regard to gender and age was carried out. Conclusion: In conclusion, frequency of carotid artery disease in patients with left main stem coronary artery disease is high in our population. Therefore, screening of carotid artery disease should be recommended in patients with CAD, especially in older patients with multivessel CAD.

Selection of Mediastinal Lymphoma Patients for Proton Therapy Within the Proton Collaborative Group Registry: Concordance With the ILROG Guidelines.

As patients with mediastinal lymphoma are typically young with curable disease, advanced radiation techniques such as proton therapy are often considered to minimize subacute and late toxicity. However, it is unclear which mediastinal lymphoma patients are treated with proton therapy. Within a prospective, multi-institutional proton registry, we characterized mediastinal lymphoma patients treated with proton therapy and assessed concordance with consensus recommendations published in 2018 by the International Lymphoma Radiation Oncology Group (ILROG). Eligible patients included those with lymphoma of the mediastinum treated exclusively with proton therapy for whom digital imaging and communications in medicine (DICOM) treatment data were available for review. Given the challenge with reliably visualizing the left mainstem coronary artery, the inferior-most aspect of the left pulmonary artery (PA) was used as a surrogate. Extent of disease was characterized as upper mediastinum (above level of left PA), middle mediastinum (below left PA but at or above level of T8), or low mediastinum (below T8). Between November 2012 and April 2019, 56 patients were treated and met inclusion criteria. Patients treated with proton therapy were young (median, 24 y; range: 12 to 88), with over half being female (55%). Patients were most commonly treated at initial diagnosis (86%) and had Hodgkin lymphoma (79%). Most patients (96%) had mediastinal disease that extended down to the level of the heart: 48% had middle and 48% had low mediastinal involvement. Nearly all patients (96%) met the ILROG consensus recommendations: 95% had lower mediastinal disease, 46% were young females, and 9% were heavily pretreated. Heart (mean) and lung dose (mean, V5, V20) were significantly associated with lowest extent of mediastinal disease. Mediastinal lymphoma patients treated with proton therapy are typically young with lower mediastinal involvement. Within a prospective, multi-institutional proton registry, nearly all treated patients fit the ILROG consensus recommendations regarding which mediastinal lymphoma patients may most benefit from proton therapy.

A Vision Of Percutaneous Coronary Revascularisation In 2021: How to take advantage of intra-coronary imaging to perform more effective PCI.

The use of intracoronary imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) can define vessel architecture and has an established role in guidance and optimisation of percutaneous coronary intervention. Additionally intracoronary imaging has an emerging role in diagnosis, afforded by the ability to depict vessel wall characteristics not seen on angiography alone. Use of intracoronary imaging is recommended by international consensus guidelines from the European Society of Cardiology and two recent expert consensus position statements from the European Association of Percutaneous Coronary Interventions (EAPCI). However, uptake in contemporary practice in the United Kingdom appears to lag behind these recommendations. Imaging is particularly advantageous in complex coronary lesions (such as left main stem coronary artery, bifurcation, or heavily calcified lesions) and in complex patients (acute presentations, atypical presentations, and renal dysfunction). Stent detail to the level of individual struts can be appreciated with intracoronary imaging, which facilitates appropriate stent selection and optimisation of the final stent result. We highlight specific subgroups that benefit from an imaging guided approach to percutaneous coronary intervention. We review the evidence and the role of intracoronary imaging and highlight specific subgroups that show particular benefit from imaging guided percutaneous coronary intervention.

Postpartum multi-vessel spontaneous coronary artery dissection in the setting of cocaine and amphetamine use: a case report

Background Spontaneous coronary artery dissection (SCAD) is a recognized cause of acute coronary syndrome (ACS). Pregnancy, the postpartum period, and illicit drug use have all been reported as potential triggers.Case summary We describe the case of a 41-year-old patient who presented to the emergency department with chest pain in the setting of recent cocaine and amphetamine use. The patient was 4 months postpartum following an uncomplicated pregnancy. Past medical history was non-contributory, with no known risk factors for ischaemic heart disease. Electrocardiogram was normal but high-sensitivity troponin T was significantly elevated. Coronary angiography revealed multi-vessel SCAD. This was managed conservatively as the patient remained clinically stable and pain free without high-risk anatomy (left main stem or proximal two-vessel coronary artery dissection).Discussion Spontaneous coronary artery dissection must be considered in a postpartum patient presenting with ACS, particularly in the context of environmental stressors such as illicit drug use. Coronary angiography is key to determine diagnosis and guide management. Conservative therapy is favoured, except for patients with ongoing ischaemia, haemodynamic instability, and left main stem involvement. In this case, we suspect SCAD occurred due to the haemodynamic effects of cocaine and amphetamines in the context of structural arterial changes of the postpartum state.

Predictors of long-term outcomes of coronary bifurcation stenting: 6-year results from international, randomized POLBOS I and POLBOS II clinical trials

Abstract Introduction Bifurcation lesions pose a therapeutic challenge during percutaneous coronary intervention (PCI). Results of regular drug-eluting stents (rDESs) in bifurcation treatment are not optimal. Purpose The aim of this study was to analyze the 6-year follow-up of BiOSS (Balton, Poland) stents in patients enrolled into two randomized clinical trials POLBOS I (NCT02192840) and POLBOS II NCT02198300). Methods The BiOSS stent is a coronary dedicated bifurcation balloon expandable stent made of 316L stainless steel and coated with a biodegradable polymer as well as the drug. The stent consists of two parts with different diameters connected with two struts of 1.9 - 2.5 mm length each. The aim of randomized POLBOS trials was to compare the BiOSS stents with regular drug eluting stents (rDES) in patients with stable CAD or NSTE-ACS (POLBOS I: paclitaxel eluting BiOSS Expert vs rDES; POLBOS II: sirolimus eluting BiOSS LIM vs rDES). Provisional T-stenting was the default strategy. Angiographic control was performed at 12 months in all patients. The primary end-point was composed MACE defined as cardiac death, myocardial infarction or target lesion revascularization (TLR). Clinical assessment was performed every year after index procedure. Results In POLBOS I trial BiOSS Expert was implanted in 120 patients (49.4%), and rDES was implanted in 123 patients. The target vessel was the left anterior descending (LAD) artery (52% vs 70%) followed by the left main stem (LMS) coronary artery (22% vs 15%). In rDES group, 38.2% of patients received paclitaxel-eluting stents. Side branch treatment with rDES was required in 10% of cases in both groups. At 12 months, the incidence of cumulative major adverse cardiovascular events (MACE) was similar in both groups: 13.3% vs 12.2% (P=0.7). The TLR rate was significantly higher in the BiOSS Expert group compared with rDES group (11.5% vs 7.3%; P=0.02). Significantly lower rates of restenosis were observed in final kissing balloon (FKB) subgroups of both the BiOSS Expert (8.1% vs 13.2%; P&amp;lt;0.05) and rDES groups (4.9% vs 9.5%; P&amp;lt;0.05). In POLBOS II 202 patients were randomly assigned 1:1 to treatment of the coronary bifurcation lesions either with the BiOSS LIM stent (n=102) or with rDES (n=100). The target vessel was the LAD (44% vs 43%) followed by the LMS (35.3% vs 38%). Side branch treatment was required in 8.8% (rDES) and 7% (BiOSS). At 12 months, the cumulative MACE incidence was similar in both groups (11.8% [BiOSS] vs. 15% [rDES, p=0.08]), as was the TLR rate (9.8% vs. 9% [p=0.8]). The binary restenosis rates were significantly lower in the FKBI subgroup of the BiOSS group (5.9% vs. 11.8%, p&amp;lt;0.05). At the time of ESC Congress 2020 we will present data from 6-year follow-up from POLBOS I trial and POLBOS II trial focusing on LM stenting and patients with diabetes. Conclusions BiOSS® stents provided satisfactory 1-year results which seemed comparable with rDES. Long-term data are pending. Funding Acknowledgement Type of funding source: None

Is it time to refresh the heart team? New paradigms for shared decision making

### Learning objectives Traditionally composed of an interventional cardiologist, non-invasive cardiologist and a cardiac surgeon, the ‘heart team’ (HT), involves a multidisciplinary approach to decision making for cardiovascular patients. Following...

Selection of Mediastinal Lymphoma Patients for Proton Therapy in a Prospective Multi-Institutional Registry: Concordance with the ILROG Guidelines

Patients with mediastinal lymphoma are young and typically have curable disease. As such, advanced RT techniques such as proton therapy (PT) are often considered to minimize late toxicity. In 2018, ILROG published guidelines that identified 3 subsets of mediastinal lymphoma patients that may derive the greatest benefit from PT: patients with disease below the left main stem coronary artery, young females, and heavily pretreated patients. Within a prospective, multi-institutional PT registry of US community and academic institutions, we evaluated concordance between clinical practice and the ILROG guidelines in regard to patient selection for PT. Patients eligible for analysis included those with lymphoma of the mediastinum treated exclusively with PT and had associated DICOM files. Given the challenge with reliably visualizing the left main stem coronary artery, the inferior-most aspect of the left pulmonary artery (PA) was used as a surrogate. Extent of disease was characterized as upper mediastinum (above level of left PA), middle mediastinum (below left PA but at or above the level of T8), or lower mediastinum (below T8). Disease extent was also characterized as whether it extended more than 3 cm below the carina. 56 patients treated between 11/2012 and 4/2019 with PT had DICOM data for review. All patients registered after 7/2017 had DICOM data for review. Median age at PT was 24 years (range, 12-88); 55.4% were female, 58.9% had stage I/II disease at initial diagnosis, and 85.7% were treated in the initial setting (versus relapsed/refractory). Histologies included Hodgkin lymphoma (78.6%), DLBCL (8.9%), PMBCL (8.9%), and other non-Hodgkin lymphoma (3.6%). Median RT dose was 30.6 Gy(RBE) (range, 19.5-54). Nearly all patients (54; 96.4%) met the ILROG inclusion criteria for consideration of PT to the mediastinum: 94.6% had disease below the left PA, 44.6% were young females (<35 years) in whom PT could reduce breast dose, and 8.9% were heavily pretreated and at higher risk of RT-associated heart and lung toxicity. Nearly half fulfilled two (48.2%) or all three (3.6%) criteria. Two patients did not fulfill the criteria—both with exclusively upper mediastinal disease. Disease extent included the upper mediastinum (3.6%), middle mediastinum (48.2%), lower mediastinum (48.2%). In 94.6% of patients, disease extended 3 cm below the carina. For disease below the left PA, disease was anterior (94.6%), right (46.4%), left (41.1%), and posterior to the heart (23.2%). Even prior to the ILROG guidelines, there was concordance among radiation oncologists regarding which mediastinal lymphoma patients may most benefit from PT. This most frequently included young patients with disease below the left PA for whom PT can reduce dose to the heart, lung, and breast tissue.

The impact of coronary perforation in percutaneous interventions involving the left main stem coronary artery in the United Kingdom 2007-2014: Insights from the British Cardiovascular Intervention Society database.

Percutaneous coronary intervention (PCI) is increasingly utilized for treatment of coronary disease involving the unprotected left main stem (ULMS). However, no studies to date have examined the outcomes of such interventions when complicated by coronary perforation (CP). Using the British Cardiovascular Intervention society (BCIS) database, data were analyzed on all ULMS-PCI procedures complicated by CP in England and Wales between 2007 and 2014. Multivariate logistic regressions were used to identify predictors of ULMS CP and to evaluate the association between this complication and outcomes. During 10,373 ULMS-PCI procedures, CP occurred more frequently than in non-ULMS-PCI (0.9 vs. 0.4%, p < .001) with a stable annual incidence. Covariates associated with CP included number of stents used, female gender, use of rotational atherectomy and chronic total occlusion (CTO) intervention. Adjusted odds of adverse outcomes for ULMS-PCI complicated by CP were higher for peri-procedural complications including cardiogenic shock, tamponade, side-branch loss, DC cardioversion, in-hospital major bleeding, transfusion requirement, and peri-procedural myocardial infarction. There were also significantly increased odds for in-hospital major adverse cardiac events (MACCE, OR 8.961, 95% CI [4.902-16.383]) and 30-day mortality (OR 5.301, 95% CI [2.741-10.251]). CP is an infrequent event during ULMS-PCI and is predicted by female gender, rotational atherectomy, CTO interventions or number of stents used. CP was associated with significantly higher odds of mortality and morbidity, but at rates similar to previously published all-comer PCI complicated by CP.

Myocardial Infarction Due to Coronary Artery Injury following High Force Blunt Trauma to the Upper Chest: A Case Illustrating the Prehospital, Hospital and Autopsy Findings

Myocardial infarction (MI) is a rare complication of blunt chest trauma (BCT). We describe an extensive antero-lateral MI due to thrombosis of the left main stem coronary artery following a blow to the lower face and upper anterior chest during an industrial accident in a 52-year-old male. The patient presented with acute left ventricular failure. Our case highlights MI as an important differential in a BCT patient presenting with hypoxia where lung pathology has been excluded. We aim to highlight the importance of cardiac assessment in trauma scenarios particularly where patients are unable to report symptoms. Our patient sadly did not survive his injuries. This case describes MI following BCT from the initial prehospital presentation through to postmortem findings and adds to the limited literature on the pathological mechanisms underpinning this rare complication.

Should the primary percutaneous coronary intervention pathway be redesigned?

Background/Aims The primary percutaneous coronary intervention pathway for patients experiencing an ST segment elevation acute coronary syndrome excludes patients with aVR ST elevation. These patients are treated on the non-ST segment elevation acute coronary syndrome pathway, which means that they have a coronary angiogram +/− intervention during their inpatient stay. Patients with non-ST segment elevation acute coronary syndrome have worse outcomes nationally. As such, research is required to demonstrate areas for improvement. This article examines the association between aVR ST segment elevation on the electrocardiogram and significant left main stem, proximal left anterior descending, or 3-vessel coronary artery stenosis in acute coronary syndrome to establish whether the primary percutaneous coronary intervention pathway should be redesigned. Methods Existing literature was searched, and relevant studies were considered and evaluated. Data were collected within local NHS Trusts on patients who had aVR ST segment elevation on the electrocardiogram. The data were analysed, and the findings were compared and synthesised with the literature. Results The study demonstrated a relationship between aVR ST segment elevation and significant disease. However, because of the numbers involved, analysis to demonstrate statistical significance was not possible, with the exception of aVR ST segment elevation and left main stem coronary artery, left anterior descending coronary artery and triple vessel disease, where p&lt;0.05 in the population with left main stem coronary artery occlusion +/− other disease. The study demonstrated that aVR ST segment elevation should be treated as an ST segment elevation acute coronary syndrome equivalent, as it is a high-risk finding. These patients should go immediately to the cardiac catheter laboratory for a primary percutaneous coronary intervention. Conclusion The need for a change in the primary percutaneous coronary intervention pathway was established.

Sudden cardiac death due to coronary artery embolism secondary to native aortic valve endocarditis in a young adult

BackgroundSystemic embolism is a common complication of infective endocarditis, most frequently involving the central nervous system, spleen, kidney, liver, and iliac or mesenteric arteries, but embolisation to coronary artery causing sudden cardiac death is infrequently encountered.Case presentationA case of a 45-year-old male who had a coiling procedure for anterior communicating artery aneurysm 6 weeks prior to his death. He was asymptomatic until a week prior to his death. The decedent had a fever and was treated for urinary tract infection with oral cefuroxime. He had a sudden onset of breathlessness and died at his home. Post mortem examination revealed a dilated aortic valve with vegetation. Part of the vegetation dislodged in the left coronary ostium and caused luminal occlusion. The left kidney showed scarred surface and poorly demarcated corticomedullary junction. However, the right kidney and urinary bladder were unremarkable. Microscopic examination revealed the septic thrombus both on the valve and in the left coronary ostium extended to the left main stem coronary artery. However, there was no evidence of myocardial ischemia. Blood culture grew Enterococcus faecalis which are usually associated with intravenous procedure and urinary tract infection. The culture from the vegetation also grew Enterococcus species. The left kidney also showed microscopic evidence of chronic pyelonephritis.ConclusionThis case highlights the rare complication of infective endocarditis which caused sudden cardiac death.

Simultaneous kissing stents to treat unprotected left main stem coronary artery bifurcation disease; stent expansion, vessel injury, hemodynamics, tissue healing, restenosis, and repeat revascularization.

ObjectivesTo perform detailed analysis of stent expansion, vessel wall stress, hemodynamics, re‐endothelialization, restenosis, and repeat PCI in the simultaneous kissing stents (SKS) technique of bifurcation left main stem (LMS) stenting.BackgroundThe SKS technique is useful to treat patients with true bifurcation disease of the LMS but remains controversial.Methods and ResultsComputational structural analysis of SKS expansion demonstrated undistorted and evenly expanded stents. Computational fluid dynamics modelling revealed largely undisturbed blood flow. 239 PCI procedures were performed on 217 patients with unprotected bifurcation LMS disease with SKS using DES (2004‐2017). We electively studied 13 stable patients from baseline to 10 years post‐SKS with repeat angiography and optical coherence tomography, and demonstrated tissue coverage of the stent struts at the carina, with no evidence of lacunae behind the stents. We studied all patients with symptomatic recurrence. Target lesion revascularization rate was 3.2% at 1 year and 4.6% at 2 years. Of all 20 patients with restenosis, the site was the LMS‐Cx stent in 7, the LMS‐LAD stent in 2 and both in 11. Two‐year recurrence rate was 7/32 (5.3%) for first, and 4/108 (3.7%) for second generation DES. Treatment with repeat kissing techniques was undertaken in 19/20, with sustained clinical results with re‐SKS.ConclusionThe SKS technique for treating unprotected LMS bifurcation disease does not distort the stents, is associated with favorable hemodynamics, tissue coverage of the exposed struts, and a low restenosis rate when performed with contemporary stents. Re‐PCI with repeat SKS appears feasible, safe, and durable.

Clinical performance of a dedicated self-apposing stent for the treatment of left main stem disease. Results of the left Main AngioplasTy wIth a Self-apposing StEnt - the MATISSE study.

In the recent years percutaneous treatment of the left main stem (LM) has gained a precise role as a result of consistent scientific evidence vs. coronary artery bypass. A self-apposing stent offers an improved adaptation to the vessel wall, especially in case of tapered vessels; aim of this study was to investigate the role of a novel self-apposing, sirolimus-eluting stent (Stentys, France) for the treatment of LM coronary artery disease. MATISSE is a retrospective, multicenter registry, which enrolled 151 patients treated with the device at 17 international centers. Primary study endpoint was the occurrence of major adverse cardiovascular events (MACE), a composite endpoint of cardiac death, target lesion revascularization (TLR) and target-vessel myocardial infarction, at 9months clinical follow-up. Secondary endpoints included procedural success, the single determinants of MACE and stent thrombosis. Lesions were located in distal LM bifurcation in 84% of the patients. Procedural success was achieved in 150 patients. The average follow-up length was 348±52days. MACE occurred in 14 (9.3%) patients with 2 (1.3%) cardiac deaths. TLR occurred in 8 patients (5.3%). There were 2 cases of definite stent thrombosis, 1 acute and 1 very late. A self-apposing stent, when used for LM PCI in a real world, high risk population, showed good immediate procedural results with low rates of adverse events at mid-term follow-up.

P530Restenosis in simultaneous kissing stents to treat unprotected left main stem coronary artery bifurcation disease: incidence and management

P530Restenosis in simultaneous kissing stents to treat unprotected left main stem coronary artery bifurcation disease: incidence and management

Iatrogenic Dissection of Left Main Stem Coronary Artery Necessitating Emergency Coronary Artery Bypass Grafting: A Rare Life Threatening Complication of Diagnostic Coronary Angiography

Iatrogenic Dissection of Left Main Stem Coronary Artery Necessitating Emergency Coronary Artery Bypass Grafting: A Rare Life Threatening Complication of Diagnostic Coronary Angiography