Unprotected Left Main Stenosis Research Articles

Catheter-based reperfusion of unprotected left main stenosis during an acute myocardial infarction (the ULTIMA experience)

The ULTIMA registry was a prospective, multicenter, international registry of 277 patients who underwent percutaneous coronary interventions of unprotected left main trunk stenosis. The 40 patients who underwent an emergency percutaneous left main intervention for acute myocardial infarction are the focus of this study. We compared the results of primary angioplasty with primary stenting, characterizing both the short-term (in-hospital) and long-term (12-month) outcomes. Of the 40 patients, 23 underwent primary angioplasty, whereas 17 underwent primary stenting. The angiographic success rate was an 88% for the cohort. The in-hospital death or coronary artery bypass grafting rate was 65% for the entire group, 74% for the percutaneous transluminal coronary angioplasty group (PTCA), and 53% for the stent group (p = 0.2). The in-hospital death rate was 55% for the entire cohort, 70% for the PTCA group, and 35% for the stent group (p = 0.1). The 12-month rate of death or bypass surgery was 83% and 58% for the PTCA and stent groups, respectively (p = 0.047). The 12-month survival rate was 35% and 53% for the PTCA and stent groups, respectively (p = 0.18). Bypass surgery was required in 6 patients in the PTCA group and 2 patients in the stent group (p = 0.07). Patients undergoing percutaneous interventions for unprotected left main myocardial stenosis during an acute myocardial infarction are critically ill; an initial percutaneous revascularization approach appears feasible and may be the preferred revascularization strategy. Primary stenting was associated with improved clinical outcomes.

Results of stenting of unprotected left main coronary artery stenosis in patients at high surgical risk

From March 1994 to September 1996, 39 patients underwent stenting of the unprotected left main coronary artery because of high surgical risk. Stenting appeared to improve clinical outcome, but there was a significant mortality rate at long-term follow-up.

Intravascular ultrasound findings in stenting of unprotected left main coronary artery stenosis

We evaluated the role of intravascular ultrasound (IVUS) in 16 patients with unprotected left main coronary artery (LMCA) stenting compared with 80 patients with other (non-LMCA) native coronary artery stenting and found that (1) additional high-pressure or larger size balloon dilations were more frequently performed in LMCA stenting than in non-LMCA stenting (p <0.05) and (2) after IVUS-guided stent implantation, minimum lumen area was > or = 9 mm2 in 88% of patients who underwent LMCA stenting and in 19% of those who underwent non-LMCA stenting (p <0.001). IVUS guidance may be a more important adjunctive imaging modality in the stenting of unprotected LMCA stenoses than in stenting of non-LMCA stenoses.

Correlates of Cardiac Death Early After Hospital Discharge in Patients who Have Undergone Percutaneous Treatment of Unprotected Left Main Stenoses - What Are the Lessons?

Correlates of Cardiac Death Early After Hospital Discharge in Patients who Have Undergone Percutaneous Treatment of Unprotected Left Main Stenoses - What Are the Lessons?

Stenting of Unprotected Left Main Coronary Artery Stenosis: Methodology, Stent Selection and Clinical Outcome

Stenting of Unprotected Left Main Coronary Artery Stenosis: Methodology, Stent Selection and Clinical Outcome

Results of Percutaneous Intervention for Unprotected Left Main Coronary Stenoses in Surgical and Non-surgical Candidates

Results of Percutaneous Intervention for Unprotected Left Main Coronary Stenoses in Surgical and Non-surgical Candidates

Stenting of “unprotected” left main coronary artery stenoses: early and late results

ObjectiveTo assess short and long term efficacy of coronary stent implantation for unprotected left main coronary artery stenosis.DesignRetrospective follow up study.SettingTertiary referral centre for interventional cardiology and cardiac surgery.PatientsEighteen consecutive...

Palmaz-Schatz Stenting in Unprotected Left Main Coronary Artery Stenosis: Immediate and Follow-up Results

Palmaz-Schatz Stenting in Unprotected Left Main Coronary Artery Stenosis: Immediate and Follow-up Results

Correlates of cardiac death early after hospital discharge in patients who have undergone percutaneous treatment of unprotected left main stenoses — what are the lessons?

Correlates of cardiac death early after hospital discharge in patients who have undergone percutaneous treatment of unprotected left main stenoses — what are the lessons?

Stenting of Unprotected Left Main Coronary Artery Stenoses: Immediate and Late Outcomes

Objectives. We examined the immediate and long-term outcomes after stenting of unprotected left main coronary artery (LMCA) stenoses in patients with normal left ventricular (LV) function.Background. Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty. Recently, several reports on protected or unprotected LMCA stenting, or both, suggested the possibility of percutaneous intervention for this prohibited area.Methods. Forty-two consecutive patients with unprotected LMCA stenoses and normal LV function were treated with stents. The post-stent antithrombotic regimens were aspirin and ticlopidine; 14 patients also received warfarin. Patients were followed very closely with monthly telephone interviews and follow-up angiography at 6 months.Results. The procedural success rate was 100%, with no episodes of subacute thrombosis regardless of anticoagulation regimen. Six-month follow-up angiography was performed in 32 of 34 eligible patients. Angiographic restenosis occurred in seven patients (22%, 95% confidence interval 7% to 37%); five patients subsequently underwent elective coronary artery bypass graft surgery (CABG), and two patients were treated with rotational atherectomy plus adjunct balloon angioplasty. The only death occurred 2 days after elective CABG for treatment of in-stent restenosis. The other patients (without angiographic follow-up) remain asymptomatic.Conclusions. Stenting of unprotected LMCA stenoses may be a safe and effective alternative to CABG in carefully selected patients with normal LV function. Further studies in larger patient populations are needed to assess late outcome.

Palmaz-Schatz stenting in unprotected left main coronary artery stenosis: immediate and follow-up results

Palmaz-Schatz stenting in unprotected left main coronary artery stenosis: immediate and follow-up results

Results of percutaneous intervention for unprotected left main coronary stenoses in surgical and non-surgical candidates

Results of percutaneous intervention for unprotected left main coronary stenoses in surgical and non-surgical candidates

Stenting of unprotected left main coronary artery stenosis: methodology, stent selection and clinical outcome

Stenting of unprotected left main coronary artery stenosis: methodology, stent selection and clinical outcome

Directional atherectomy or stenting for unprotected left main coronary stenoses — the ULTIMA group experience

Directional atherectomy or stenting for unprotected left main coronary stenoses — the ULTIMA group experience

Coronary stenting of unprotected left main stem stenoses in elderly patients unsuitable for coronary surgery

We describe five patients with severe unstable angina refractory to medical management in whom coronary angiography demonstrated a severe stenosis of the left main stem. Due to severe co-existing illnesses bypass surgery was deemed inappropriate. Angioplasty to the left main stem stenosis followed by stent deployment was performed. All five patients were successfully discharged from hospital.

Primary Intracoronary Stenting of Unprotected Left Main Coronary Artery Stenosis in Two Patients with No Contraindication to Surgery: Immediate and Follow‐Up Results

Although successful stenting has been reported on protected left main coronary artery or unprotected left main in patients with prohibitive surgical risks or in bail‐out situations, no case of left main primary stent implantation in patients without surgical contraindication has yet been reported. We report immediate and late clinical and angiographic results in two patients (57 and 38‐year‐old men) who had unprotected left main coronary disease, with isolated stenosis on a large and long left main trunk, ideally suitable for stenting. We believe that stenting could change the matter of the contraindication of balloon angioplasty in left main coronary disease. However, further studies with a large number of patients and long‐term follow‐up are necessary to determine whether this approach will constitute a valuable alternative to surgery in the future.

Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multicenter registry analysis 1994-1996.

Coronary artery bypass surgery (CABG) has been considered the therapy of choice for patients with unprotected left main (ULMT) coronary stenoses. Selected single-center reports suggest that the results of percutaneous intervention may now approach those of CABG. To assess the results of percutaneous ULMT treatment from a wide variety of experienced interventional centers, we requested data on consecutive patients treated after January 1, 1994, from 25 centers. One hundred seven patients were identified who were treated either electively (n=91) or for acute myocardial infarction (n=16). Of patients treated electively, 25% were considered inoperable, and 27% were considered high risk for bypass surgery. Primary treatment included stents (50%), directional atherectomy (24%), and balloon angioplasty (20%). Follow-up was 98.8% complete at 15+/-8 months. Results varied considerably, depending on presentation and treatment. For patients with acute myocardial infarction, technical success was achieved in 75%, and survival to hospital discharge was 31%. For elective patients, technical success was achieved in 98.9%, and in-hospital survival was strongly correlated with left ventricular ejection fraction (P=.003). Longer-term event (death, infarction, or bypass surgery) -free survival was correlated with ejection fraction (P<.001) and was inversely related to presentation with progressive or rest angina (P<.001). Surgical candidates with ejection fractions > or = 40% had an in-hospital survival of 98% and a 9-month event-free survival of 86+/-5%, whereas patients with ejection fractions < 40% had 67% and 22+/-12% in-hospital and 9-month event-free survivals, respectively. Nine hospital survivors (10.6%) experienced cardiac death within 6 months of hospital discharge. While results for selected patients appear promising, until early post-hospital discharge cardiac death can be better understood and minimized, percutaneous revascularization of ULMT stenosis should not be considered an alternative to bypass surgery for most patients. When percutaneous revascularization of ULMT is required, directional atherectomy and stenting appear to be the preferred techniques, and follow-up angiography 6 to 8 weeks after treatment is probably advisable.

Stenting of Unprotected Left Main Coronary Artery Stenosis without Anticogulation: Immediate and Late Outcomes

Stenting of Unprotected Left Main Coronary Artery Stenosis without Anticogulation: Immediate and Late Outcomes

Stenting of unprotected left main coronary artery stenosis without coumadin

Stenting of unprotected left main coronary artery stenosis without coumadin

Treatment of unprotected left main stenoses with Palmaz‐Schatz stenting

Treatment of unprotected left main stenoses with Palmaz‐Schatz stenting