Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention-Our Experiences at a Tertiary Hospital

2014 ◽  
Vol 6 (2) ◽  
pp. 107-111
Author(s):  
S Munwar ◽  
AHMW Islam ◽  
S Talukder ◽  
AQM Reza ◽  
T Ahmed ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Bare Metal ◽  
Coronary Artery Diseases ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Drug Eluting

Background: Aim of the study was to evaluate the primary procedural success of percutaneous coronary intervention of unprotected left main coronary artery stenosis using either Bare-metal stents or drug eluting stent. Methods: Total 33 patients were enrolled in this very preliminary non-randomized prospective cohort study. Among them, Male: 25 and Female: 8. Total 35 stents were deployed. Mean age were for Male: 59 yrs, for Female: 62 yrs. Associated coronary artery diseases risk factors were dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive family history for coronary artery diseases and smoking. Results: Among the study group; 26 (78%) were Dyslipidemic, 24(70%) were hypertensive; 17 (51.5%) patients were Diabetic, 11(33%) were smoker and 7(21%) patients had family history of Ischaemic heart disease. Female patients were more obese (BMI M 26: F 27) and developed coronary artery diseases in advance age. Common stented territory were left main: 20 (60%), Left main to left anterior descending artery 7 (22%) and Left main to left circumflex artery 6 (18%). Average length and diameter of stent was 3.5 and 18 mm respectively. Stent used: Bare Metal Stent 5 (15%), Drug Eluting Stent: 28 (85%). Among the different Drug Eluting Stents, Everolimus eluting stents were 11 (39.3%), Sirolimus eluting 10(35.7%), Paclitaxel eluting 3 (10.7%), Biolimus eluting 3 (10.7%) and Zotarolimus eluting1 (3.6%). In the present study, overall survival outcome was 94% (31 patient), mortality of cardiac cause 3% (1 patient) and 1 patient (3%) died of hepatocellular carcinoma. Conclusion: Our study has shown that percutaneous coronary intervention of the unprotected left main is a safe and effective alternative to Coronary Artery Bypass Graft (CABG). DOI: http://dx.doi.org/10.3329/cardio.v6i2.18349 Cardiovasc. j. 2014; 6(2): 107-111

scholarly journals Successful treatment of left main coronary artery total occlusion combined with cardiogenic shock

2019 ◽  
Vol 47 (8) ◽  
pp. 3940-3945 ◽  
Author(s):  
Xing Yu ◽  
Jian-Yi Zheng ◽  
Gui-Ping Zhu
Keyword(s):  
Coronary Artery ◽  
Cardiogenic Shock ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Left Main ◽  
Total Occlusion ◽  
Appropriate Treatment ◽  
Percutaneous Coronary ◽  
Drug Eluting

Acute myocardial infarction (AMI) caused by total occlusion of the left main coronary artery (LMCA) is a catastrophic event. However, the clinical features and appropriate treatment of patients with this condition remain unclear. We report a man with total occlusion of the LMCA presenting with AMI combined with cardiogenic shock. He was successfully treated with angioplasty and drug-eluting stent implantation assisted by an intra-aortic balloon pump (IABP). This case suggests that percutaneous coronary intervention may be an optional therapeutic strategy in these patients, and that IABP implantation could improve clinical outcomes. A dominant right coronary artery and enhanced collateral circulation were considered to be key features related to the patient’s survival.

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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