EXPEDITED REVIEW
Serial Angiographic Follow-Up of Sirolimus-Eluting Stents for Unprotected Left Main Coronary Artery Revascularization
Matthew J. Price, MD, FACC*,
Ecaterina Cristea, MD ,
Neil Sawhney, MD*,
John A. Kao, MD, FACC*,
Jeffrey W. Moses, MD, FACC, ,
Martin B. Leon, MD, FACC,,
Ricardo A. Costa, MD,
Alexandra J. Lansky, MD, FACC, and
Paul S. Teirstein, MD, FACC*,,*
* Division of Cardiovascular Disease, Scripps Clinic, La Jolla, California
Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
Manuscript received July 27, 2005;
revised manuscript received October 25, 2005,
accepted October 31, 2005.
* Reprint requests and correspondence: Dr. Paul S. Teirstein, Scripps Clinic, 10666 North Torrey Pines Road, Maildrop S1056, La Jolla, California 92037. (Email: Teirstein.Paul{at}scrippshealth.org).
OBJECTIVES: This study was performed to evaluate the clinical and serial angiographic outcomes of patients undergoing sirolimus-eluting stent (SES) implantation for unprotected left main coronary artery (LMCA) stenosis.
BACKGROUND: The efficacy of SES has led to their expanded use for off-label indications, including LMCA disease.
METHODS: Unprotected LMCA intervention with SES was attempted in 50 patients. Surveillance angiography was performed at three and nine months’ follow-up.
RESULTS: The target lesion involved the distal LMCA in 47 patients (94%). In-lesion restenosis occurred in 21 patients (42%), was focal in 85% of cases, and in 82% involved the branch ostia, sparing the LMCA itself. Target lesion revascularization (TLR) occurred in 19 patients (38%) over a mean follow-up of 276 ± 57 days; TLR was ischemia-driven in 7 patients (14%). Late loss was significantly greater within the left circumflex (LCX) ostium compared to the parent vessel (PV) of the LMCA bifurcation (0.83 ± 0.89 mm vs. 0.49 ± 0.72 mm, p = 0.04). Late loss continued to increase between three- and nine-month follow-up. Final minimal luminal diameter and maximal balloon pressure were independent predictors of restenosis of the PV.
CONCLUSIONS: Restenosis is a frequent finding when serial angiographic follow-up is performed after SES implantation for unprotected distal LMCA lesions. Restenosis is usually focal, most often involves the LCX ostium, and often occurs without symptoms.
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Abbreviations and Acronyms
| | CABG = coronary bypass surgery | | DES = drug-eluting stents | | IVUS = intravascular ultrasound | | LAD = left anterior descending coronary artery | | LCX = left circumflex artery | | LMCA = left main coronary artery | | MACE = major adverse cardiac events | | MI = myocardial infarction | | MLD = minimal luminal diameter | | PCI = percutaneous coronary intervention | | RVD = reference vessel diameter | | SES = sirolimus-eluting stent | | TLR = target lesion revascularization |
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