Clinical and angiographic outcome of stenting of unprotected left main coronary artery bifurcation narrowing

Abstract

PURPOSE: Improvements in techniques and equipments may result in the wider applicability of percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis. This report is a prospective study focused on the feasibility, effectiveness and long‐term results of stenting for treatment of ULMCA bifurcation lesions. METHODS: From November 2002 to October 2003, 57 consecutive patients were stented with bare metal stents and the technique of kissing balloon followed by T‐provisional stenting was applied for ostial left anterior descending, left circumflex or distal left main coronary lesion. RESULTS: Mean age was 69.5±10.7 years. Acute coronary syndrome occurred in 68.4% of patients with a majority of two or three vessel disease (45.10% and 35.30% respectively). GpIIbIIIa inhibitors were used in only 5.8% of cases. Angiographic success was obtained in 100% of patients. Hospital stay was 7.03±2.26 days without major adverse cardiac events. At eight months follow‐up, cardiac death was 1.7%, non‐fatal myocardial infarction 5.1% and target vessel revascularisation 22.8% including CABG 15.7% and repeated PCI 10.5% with an angiographic restenosis rate of 29.8%. CONCLUSION: In the setting of coronary stenting of the ULMCA stenosis, the use of bare metal stents can no longer be considered contemporary technique and another strategy such as coated stent may be needed.

• Coronary stenting
• left main
• bare metal stent
• restenosis
• bifurcation narrowing