Treatment Of Left Main Stenosis Research Articles

Intraoperative visualization of a deformed left main stent during surgical aortic valve replacement

BackgroundWhile coronary artery bypass grafting is typically considered first choice for the treatment of left main stenosis, there is a trend towards left main stenting due to a steadily aging population in western countries with a high operative risk and patients with single vessel coronary artery disease affecting the left main artery. Nevertheless left main stenting remains controversial, especially in patients with concomitant indications for open-heart surgery.Case presentationWe want to present a case of a 78-year-old male patient with high-grade aortic stenosis who underwent surgical aortic valve replacement at our heart center due to anatomical contraindications for transcatheter aortic valve replacement. Stenting of the left main coronary artery was performed three years earlier due to single vessel coronary artery disease while moderate aortic valve stenosis was under surveillance at the time of the intervention. Intraoperatively we found the stent to be deformed inside the left main coronary artery, covering nearly 25% of the coronary ostium. So injection of cardioplegia directly into this ostium, as we perform normally, was not possible without further damaging the stent and/or the opening of the ostium. We had to insert cardioplegia via the retrograde way, so via the coronary sinus.ConclusionWhile left main stenting can be reasonable for a specific population of patients, it should be used cautiously in patients with concomitant indications for open-heart surgery in the near future and a low perioperative risk profile.

Modified T stenting for leftmain trifurcation stenosis in a patient with multiple co-morbidities through transradial route

A critical lesion in the left main coronary artery (LMCA) has been observed in 3%–5% of all the patients undergoing coronary angiography. Significant LMCA disease is considered as the lesion with the highest prognostic value in the coronary system because of the extent of jeopardised myocardium. Though CABG is considered as gold standard for treatment of left main stenosis, particularly distal left main, evidence is increasing to support the use of PCI with stenting in some cases . We report here a case of an elderly male with peripheral vascular disease and distal left main trifurcation disease with critical stenosis of ostial LAD and ostial LCX, who was treated by us with PCI of the distal left main trifurcation with a modified T stenting technique through the transradial route.