scholarly journals Use of Intravascular Ultrasound Imaging in Percutaneous Coronary Intervention to Treat Left Main Coronary Artery Disease

2017 ◽  
Vol 12 (01) ◽  
pp. 8 ◽  
Author(s):  
Giovanni Luigi De Maria ◽  
Adrian P Banning ◽  
◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Careful Consideration ◽  
Intravascular Imaging ◽  
Left Main ◽  
Percutaneous Coronary

Due to its potential prognostic implications and technical complexity, revascularisation of left main coronary artery (LMCA) disease requires careful consideration. Since publication of the results of the SYNTAX study, and more recently the EXCEL and NOBLE trials, there has been particular interest in percutaneous revascularisation of the LMCA. It is becoming clear that percutaneous revascularisation of LMCA disease requires appropriate lesion preparation and carefully optimised stenting in order to offer patients a treatment option as effective as coronary artery bypass grafting. For this reason intravascular imaging, and especially intravascular ultrasound, is becoming a key procedural step in LMCA percutaneous coronary intervention. In the current review paper we analyse the role of intravascular imaging with intravascular ultrasound in LMCA percutaneous coronary intervention, focusing on the main applications in this context from lesion assessment to stent sizing and optimisation.

Percutaneous coronary intervention for unprotected and protected left main stem disease

2010 ◽  
pp. 313-332
Author(s):  
Christine Hughes ◽  
Bruno Farah ◽  
Jean Fajadet
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Left Main ◽  
Coronary Bypass Grafting ◽  
Percutaneous Coronary

Significant unprotected left main coronary artery (ULMCA) disease occurs in 5–7% of patients undergoing coronary angiography (and patients with ULMCA disease treated medically have a 3-year mortality rate of 50%. Several studies have shown a significant benefit following treatment of left main (LM) stenosis with coronary bypass grafting compared with medical treatment. Until recently coronary bypass grafting has been the gold standard therapy for LM disease. However, advances in percutaneous intervention techniques and stent technology have allowed re-evaluation of the role of percutaneous coronary intervention (PCI) for LM disease. Recent studies have focused on the safety and efficacy of stenting the left main coronary artery (LMCA) to determine if it does provide a true alternative to coronary artery bypass grafting (CABG). So should we stent the LM?

Percutaneous coronary intervention for left main coronary artery stenosis

2018 ◽  
pp. 305-314
Author(s):  
Michael Mahmoudi ◽  
Nick Curzen ◽  
Christine Hughes ◽  
Bruno Farah ◽  
Jean Fajadet
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Efficacy And Safety ◽  
Left Main ◽  
Main Coronary Artery Stenosis ◽  
Percutaneous Coronary ◽  
Artery Disease

Significant left main coronary artery disease (LMCAD) occurs in 5–7% of patients undergoing coronary angiography. Patients with LMCAD have a 50% 3-year mortality despite optimal medical therapy. As such, coronary artery bypass grafting (CABG) emerged as the gold standard therapy for the treatment of patients with LMCAD either in isolation or in association with disease elsewhere in the coronary circulation. Advances in stent and adjunctive intracoronary imaging as well as pharmacotherapy has enabled percutaneous coronary intervention (PCI) to challenge CABG in such patients, with a host of randomized and observational studies comparing the safety and efficacy of PCI with CABG. This chapter covers historical data on CABG in LMCAD, compares various PCI techniques with CABG, and finally evaluates the differences in efficacy and safety.

Abstract 1846: Coronary Artery Bypass Surgery is superior to Percutaneous Coronary Intervention With Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Gengo Sunagawa ◽  
Tatsuhiko Komiya ◽  
Nobushige Tamura ◽  
Taira Kobayashi ◽  
Tomokuni Furukawa ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Drug Eluting

(Introduction) Improvements in results of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have been extending their use in patients with unprotected left main coronary artery (ULMCA) disease. (Hypothesis) We assessed the hypothesis that coronary artery bypass grafting (CABG) would be superior to PCI with DES in patients with ULMCA. (Methods) From January 2004 to March 2006, 114 patients underwent CABG (emergency: 42 cases), and 136 patients underwent PCI with DES (emergency: 9 cases) for ULMCA disease. In CABG, 91 patients had off-pump surgery. In PCI, all patients had sirolimus-eluting stent implantation. The mean follow-up was 621±291 days in CABG and 455±216 days in PCI. Survival, major adverse cardiac events (MACE), and target lesion revascularization (TLR) were analyzed by the Kaplan-Meier method. (Results) Preoperative characteristics and risk factors were compatible between the groups except for EuroSCORE (8.0±3.5 in CABG and 5.0±3.0 in PCI, p<0.0001). Thirty-day mortality was 3.5% (elective cases 0%) in CABG and 0% in PCI. Survival rate at 2 years was 94.2% in CABG and 90.2% in PCI (p=0.25). Survival rate at 2 years excluding emergent cases was 98.2% in CABG and 91.2% in PCI (p<0.05)(Figure ). MACE-free rate at 2 years was 93.5% in CABG and 59.7% in PCI (p<0.0001). Freedom from TLR was 98.0% in CABG and 58.8% in PCI (p<0.0001). During the follow-up period, there were 2 late deaths in CABG and 11 late deaths (including 5 sudden deaths) in PCI. (Conclusions) CABG was superior to PCI with DES in terms of long-term outcomes including survival, MACE-free, and TLR. DES carried higher risk for sudden death which might be associated with stent thrombosis. Survival curve in elective cases

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