scholarly journals Results of stenting the left main lesions in patients with stable coronary artery disease using biodegradable polymer and permanent polymer stents

2018 ◽  
Vol 22 (3) ◽  
pp. 49
Author(s):  
R. U. Ibragimov ◽  
A. G. Badoyan ◽  
D. A. Khelimskiy ◽  
O. V. Krestyaninov ◽  
E. A. Pokushalov ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Conflict Of Interest ◽  
De Novo ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Left Main ◽  
Cardiac Events ◽  
Stent Type ◽  
Artery Disease

<p><strong>Background.</strong> Routine coronary angiography reveals about 4–10% cases of the left main lesions in patients with different forms of coronary artery disease. With the advance of stenting technologies, percutaneous coronary intervention in this type of lesions might be an alternative to coronary artery bypass grafting in some patients. Despite a significant technical progress and current generations of drug-eluting stents, the issue of optimal dual antiplatelet therapy (DAAT) duration to minimize hemorrhagic complications in the long-term period is still an open question. The problem is especially acute in the case of left main lesions. <br /><strong>Aim.</strong> To evaluate clinical outcomes of unprotected left main stenting using Synergy stents (Boston Scientific) followed by 4-month DAAT and Xience Prime stents (Abbott Vascular) followed by 12-month DAAT.<br /><strong>Methods.</strong> Fifty patients with stable coronary artery disease were randomized into two groups depending on the stent type (Synergy and Xience). The subjects were evaluated in 12 months after the stenting procedure.<br /><strong>Results.</strong> 100 % success was achieved in the study. At 3-month check-up, the indicators of endothelialization, strut overlapping and late lumen bore did not statistically differ in the groups under study. During 12-month follow-up 2 cases of restenosis were recorded, one in each group, which required revascularization. The remaining cases of repeated revascularization were associated with de novo lesions. The overall major cardiac events rate was 4% in the Xience group and 8% in the Synergy group. In one case, myocardial infarction in the Synergy group was associated with the right coronary artery.<br /><strong>Conclusion.</strong> While treating patients with left main lesions, the use of Synergy stents followed by 4-month DAAT has no lesser clinical efficacy and safety than the Xience stents followed by 12-month DAAT. <br /><br />Received 28 August 2018. Revised 8 October 2017. Accepted 8 November 2018.<br /><strong>Funding:</strong> The study did not have sponsorship.<br /><strong>Conflict of interest:</strong> Authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conception and study design: R.U. Ibragimov, O.V. Krestyaninov<br />Data collection and analysis: R.U. Ibragimov, D.A. Khelimskiy, A.G. Badoyan <br />Statistical analysis: R.U. Ibragimov, D.A. Khelimskiy, A.G. Badoyan<br />Drafting the article: R.U. Ibragimov, D.A. Khelimskiy, A.G. Badoyan<br />Revision of the article: R.U. Ibragimov, O.V. Krestyaninov, E.A. Pokushalov, A.B. Romanov<br />Final approval of the version to be published: R.U. Ibragimov, A.G. Badoyan, D.A. Khelimskiy, O.V. Krestyaninov, E.A. Pokushalov, A.B. Romanov<br /><strong>ORCID ID</strong><br />E.A. Pokushalov, https://orcid.org/0000-0002-2560-5167</p>

The Contemporary Management of Left Main Coronary Artery Disease

2021 ◽  
Vol 17 ◽  
Author(s):  
Jonathan A. Mailey ◽  
Mark S. Spence
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Current Evidence ◽  
Drug Eluting Stent ◽  
Left Main ◽  
Main Coronary Artery Disease ◽  
Current Evidence Base ◽  
Artery Disease

: The ‘gold standard’ in the management of left main coronary artery disease has historically been coronary artery bypass surgery. Recent innovations in drug-eluting stent technology coupled with the increasing utility of physiology and imaging guidance for procedures has led to an evolving role for percutaneous coronary intervention in left main disease of low and intermediate anatomical complexity. This revascularization modality carries the clear advantage of being less invasive and significantly reducing recovery times. This practice is currently supported by international guidelines. However, it remains a controversial topic in the field of interventional cardiology, and the longer-term outcomes from a percutaneous strategy have been questioned. This review describes the current evidence base for the assessment and choice of intervention in left main coronary artery disease. The percutaneous revascularization techniques and use of imaging to optimize procedures and improve clinical outcomes will be discussed.

Long-term prognosis after percutaneous or surgical revascularization in patients with diabetes mellitus and complex coronary artery disease- a systematic review and meta analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
S Mandava ◽  
S Pothuru ◽  
S Adeel Hassan ◽  
D Missael Rocha Castellanos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Left Main ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background-Whether Coronary artery bypass grafting (CABG) confers a survival benefit in patients with diabetes mellitus(DM) and complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD) after a follow up period ≥ 5 years remains unknown. Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to December 12th 2020. Using a generic invariance weighted random effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) which was defined as a composite of death, myocardial reinfarction and stroke at ≥ 5 years. Results-A total of 8 studies with 13336 participants(PCI = 6783, CABG = 6553)were included in our analysis. Mean age was 54.6 and 55.3 in the PCI-DES and CABG groups respectively. The 5-yr follow-up outcomes including all-cause mortality (HR 1.37; 95%CI 1.15-1.65; p = 0.0006, I2 = 0)and MACCE (HR 1.48; 95%CI 1.29-1.69; p &lt; 0.00001, I2 = 0) were significantly higher with PCI as compared to CABG. Furthermore, at &gt;5 year follow-up, all-cause mortality (HR 1.35; 95%CI 1.10-1.66; p = 0.004, I2 = 37) and MACCE (HR 1.98; 95%CI 1.85-2.12; p &lt; 0.00001, I2 = 0) had similar outcomes. Conclusion-Amongst patients with DM and Complex CAD ( left main/MVD), CABG was associated with improved long-term mortality and freedom from MACCEs as opposed to PCI-DES. CABG is the preferred revascularization strategy in patients with complex anatomic disease and concurrent diabetes. Abstract Figure.

A Survey of Transesophageal Echocardiography

2018 ◽  
pp. 65-68
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Syntax Score ◽  
Severe Coronary Artery Disease ◽  
Left Main ◽  
Attractive Option ◽  
Severe Coronary Artery ◽  
Artery Disease

This case focuses on the use of cardiac stents vs. coronary artery bypass surgery for severe coronary artery disease by asking the question: Should patients with severe coronary artery disease (three-vessel and/or left main disease) be treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)? For patients with three-vessel and/or left main coronary artery disease, CABG reduced rates of major cardiovascular and cerebrovascular events compared with PCI. This difference was largely driven by a reduction in the need for repeat revascularization procedures among patients receiving CABG. Patients who received PCI had a lower rate of stroke, however, which may make PCI an attractive option for some patients. In addition, the authors suggest that patients with less complex coronary artery disease (as assessed using the SYNTAX score) may be particularly good candidates for PCI, but this hypothesis requires further validation.

Sign in / Sign up

Export Citation Format

Share Document