CLINICAL STUDY
Elective stenting of unprotected left main coronary artery stenosis
Effect of debulking before stenting and intravascular ultrasound guidance
Seung-Jung Park, MD, PhD, FACC*,
Myeong-Ki Hong, MD, PhD*,
Cheol Whan Lee, MD, PhD*,
Jae-Joong Kim, MD, PhD*,
Jae-Kwan Song, MD, PhD, FACC*,
Duk-Hyun Kang, MD, PhD*,
Seong-Wook Park, MD, PhD, FACC* and
Gary S. Mintz, MD, FACC
* Department of Medicine, College of Medicine, University of Ulsan, Cardiac Center, Asan Medical Center, Seoul, South Korea
Cardiovascular Research Foundation, New York, New York, USA
Manuscript received September 27, 2000;
revised manuscript received April 3, 2001,
accepted June 19, 2001.
Reprint requests and correspondence: Dr. Seung-Jung Park, Department of Medicine, University of Ulsan, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea
sjpark{at}www.amc.seoul.kr
OBJECTIVES
We sought to evaluate: 1) the long-term outcomes of 127 selected patients receiving unprotected left main coronary artery (LMCA) stenting; and 2) the impact of the debulking procedure before stenting and intravascular ultrasound (IVUS) guidance on their clinical outcomes.
BACKGROUND
The long-term safety of stenting of unprotected LMCA stenoses has not been established yet.
METHODS
A total of 127 consecutive patients with unprotected LMCA stenosis and normal left ventricular function were treated by elective stenting. The long-term outcomes were evaluated between two groups: IVUS guidance (n = 77) vs. angiographic guidance (n = 50); and debulking plus stenting (debulking/stenting; n = 40) vs. stenting only (n = 87).
RESULTS
Angiographic restenosis was documented in 19 (19%) of 100 patients. The lumen diameter after stenting was significantly larger in IVUS-guided group (p = 0.003). The angiographic restenosis rate was significantly lower in the debulking/stenting group (8.3% vs. 25%, p = 0.034). The reference artery size was the only independent predictor of angiographic restenosis. During follow-up (25.5 ± 16.7 months), there were four deaths, but no nonfatal myocardial infarctions occurred. The survival rate was 97.0 ± 1.7% at two years.
CONCLUSIONS
These data suggest that stenting of unprotected LMCA stenosis might be associated with a favorable long-term outcome in selected patients. Guidance with IVUS may optimize the immediate results, and debulking before stenting seems to be effective in reducing the restenosis rate. However, we need a large-scale, randomized study.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft surgery | | CI | = confidence interval | | CSA | = cross-sectional area | | EEM | = external elastic membrane | | IVUS | = intravascular ultrasound | | LAD | = left anterior descending coronary artery | | LMCA | = left main coronary artery | | MLD | = minimal lumen diameter | | OR | = odds ratio | | QCA | = quantitative coronary angiography |
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|
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|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
T. Takagi, G. Stankovic, L. Finci, K. Toutouzas, A. Chieffo, V. Spanos, F. Liistro, C. Briguori, N. Corvaja, R. Albero, et al.
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106(6):
698 - 702.
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|
|
|
|
