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. 1998 Feb;79(2):148–152. doi: 10.1136/hrt.79.2.148

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

C Laruelle 1, G Brueren 1, S Ernst 1, E Bal 1, G Mast 1, M Suttorp 1, A B de la Riviere 1, T Plokker 1
PMCID: PMC1728596  PMID: 9538307

Abstract

Objective—To assess short and long term efficacy of coronary stent implantation for unprotected left main coronary artery stenosis.
Design—Retrospective follow up study.
Setting—Tertiary referral centre for interventional cardiology and cardiac surgery.
Patients—Eighteen consecutive patients (12 men; age 70.8 years) between May 1993 and July 1996. Ten patients presented with stable angina and underwent the procedure electively, eight patients presented either with unstable angina or myocardial infarction and underwent the procedure in emergency.
Intervention—Johnson and Johnson Palmaz-Schatz stents were used in 16 patients, and a Microstent and a Gianturco-Roubin in one patient each. An intra-aortic balloon pump was prophylactively used for two patients in the elective group. In the acute group, six required an intra-aortic balloon pump.
Main outcome measures—Procedural success rate and major adverse cardiac events.
Results—Successful stent implantation was achieved in all patients. In the elective group, no major adverse cardiac event occurred during the procedure, but one patient had to undergo repeated angioplasty before discharge. All patients of the elective group were discharged alive and there has been one non-cardiac death during a follow up of (mean (SD)) 10 (4) months. In the emergency group, one patient died during the procedure, one patient developed a non Q-wave myocardial infarction, one patient underwent emergency coronary bypass surgery, while another patient died suddenly before hospital discharge. Six patients of the emergency group were discharged alive and there has been one non-cardiac death during a follow up of 7 (4) months.
Conclusions—Elective stent implantation for unprotected left main coronary artery stenosis is safe and effective in selected stable patients. Urgent stent implantation, however, cannot be considered as a definitive procedure in emergency situation.

 Keywords: stent;  left main coronary artery disease

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Figure 1  .

Figure 1  

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Left main coronary artery stenosis in right oblique view.

Figure 2  .

Figure 2  

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Left main coronary artery after stent implantation in right oblique view.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chaitman B. R., Fisher L. D., Bourassa M. G., Davis K., Rogers W. J., Maynard C., Tyras D. H., Berger R. L., Judkins M. P., Ringqvist I. Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the Collaborative Study in Coronary Artery Surgery (CASS). Am J Cardiol. 1981 Oct;48(4):765–777. doi: 10.1016/0002-9149(81)90156-9. [DOI] [PubMed] [Google Scholar]
  2. Conley M. J., Ely R. L., Kisslo J., Lee K. L., McNeer J. F., Rosati R. A. The prognostic spectrum of left main stenosis. Circulation. 1978 May;57(5):947–952. doi: 10.1161/01.cir.57.5.947. [DOI] [PubMed] [Google Scholar]
  3. Dion R., Verhelst R., Matta A., Rousseau M., Goenen M., Chalant C. Surgical angioplasty of the left main coronary artery. J Thorac Cardiovasc Surg. 1990 Feb;99(2):241–250. [PubMed] [Google Scholar]
  4. Eldar M., Schulhoff N., Herz I., Frankel R., Feld H., Shani J. Results of percutaneous transluminal angioplasty of the left main coronary artery. Am J Cardiol. 1991 Jul 15;68(2):255–256. doi: 10.1016/0002-9149(91)90755-a. [DOI] [PubMed] [Google Scholar]
  5. Fischman D. L., Leon M. B., Baim D. S., Schatz R. A., Savage M. P., Penn I., Detre K., Veltri L., Ricci D., Nobuyoshi M. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med. 1994 Aug 25;331(8):496–501. doi: 10.1056/NEJM199408253310802. [DOI] [PubMed] [Google Scholar]
  6. Kimura T., Yokoi H., Nakagawa Y., Tamura T., Kaburagi S., Sawada Y., Sato Y., Yokoi H., Hamasaki N., Nosaka H. Three-year follow-up after implantation of metallic coronary-artery stents. N Engl J Med. 1996 Feb 29;334(9):561–566. doi: 10.1056/NEJM199602293340903. [DOI] [PubMed] [Google Scholar]
  7. Macaya C., Alfonso F., Iñiguez A., Goicolea J., Hernandez R., Zarco P. Stenting for elastic recoil during coronary angioplasty of the left main coronary artery. Am J Cardiol. 1992 Jul 1;70(1):105–107. doi: 10.1016/0002-9149(92)91400-x. [DOI] [PubMed] [Google Scholar]
  8. O'Keefe J. H., Jr, Hartzler G. O., Rutherford B. D., McConahay D. R., Johnson W. L., Giorgi L. V., Ligon R. W. Left main coronary angioplasty: early and late results of 127 acute and elective procedures. Am J Cardiol. 1989 Jul 15;64(3):144–147. doi: 10.1016/0002-9149(89)90447-5. [DOI] [PubMed] [Google Scholar]
  9. Serruys P. W., de Jaegere P., Kiemeneij F., Macaya C., Rutsch W., Heyndrickx G., Emanuelsson H., Marco J., Legrand V., Materne P. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med. 1994 Aug 25;331(8):489–495. doi: 10.1056/NEJM199408253310801. [DOI] [PubMed] [Google Scholar]
  10. Sigwart U., Puel J., Mirkovitch V., Joffre F., Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med. 1987 Mar 19;316(12):701–706. doi: 10.1056/NEJM198703193161201. [DOI] [PubMed] [Google Scholar]
  11. Stertzer S. H., Myler R. K., Insel H., Wallsh E., Rossi P. Percutaneous transluminal coronary angioplasty in left main stem coronary stenosis: a five-year appraisal. Int J Cardiol. 1985 Oct;9(2):149–159. doi: 10.1016/0167-5273(85)90194-9. [DOI] [PubMed] [Google Scholar]
  12. Takaro T., Peduzzi P., Detre K. M., Hultgren H. N., Murphy M. L., van der Bel-Kahn J., Thomsen J., Meadows W. R. Survival in subgroups of patients with left main coronary artery disease. Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease. Circulation. 1982 Jul;66(1):14–22. doi: 10.1161/01.cir.66.1.14. [DOI] [PubMed] [Google Scholar]

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