PTCA of the left main stem following protective coronary artery bypass grafting.
ABSTRACT Percutaneous transluminal coronary angioplasty (PTCA) was performed in 14 patients with significant left main stem stenosis following protective coronary artery bypass grafting (CABG). The procedure was successful in 13/14 patients (93%), achieving a decrease in mean diameter stenosis from 74% +/- 7% to 31% +/- 12% (P less than 0.01). Accordingly, the absolute stenosis diameter increased from 0.9 mm +/- 0.3 mm to 2.4 mm +/- 0.5 mm (P less than 0.01). Dissection of the left main stem artery and a transient significant fall of blood pressure each occurred in one patient. No other serious complications were noted. Eight of 13 patients (62%) with successful PTCA underwent control angiography. Restenosis had occurred in 3 of 8 patients (38%) with total occlusion of the left main stem in 1 patient. All bypass grafts were found to be patent at follow-up. Clinical evaluation in all 14 patients revealed no serious events (death, myocardial infarction, repeat revascularization procedure) during a mean follow-up period of 27 months (range 6-39 months). PTCA of the left main stem following CABG can be considered a relatively safe and effective procedure with a marked restenosis-rate but beyond that, an uncomplicated long-term follow-up.
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ABSTRACT: The poor prognosis of patients with symptomatic left main coronary artery (LM) atherosclerosis treated medically could be improved considerably by coronary artery bypass graft (CABG) surgery. The first percutaneous transluminal interventions of LM stenosis revealed that such procedures were quite difficult to perform and that early mortality was too high to be accepted as a standard treatment. As a consequence, in 1984, the National Heart, Lung, and Blood Institute published a consensus that stenoses of the LM were a contraindication to percutaneous transluminal coronary angioplasty. However, percutaneous inter- ventions on the LM remained in scope, as some patients with high risk for CABG, with contraindications to CABG or with very limited life expectancy still had no other option than a percutaneous intervention of the LM. Furthermore, in the last years, new percutaneous techniques have been developed for interventional cardiology: the use of stents or atherectomy, the use of assist devices like intraaortic balloon pumps or cardio-pulmonary support devices improved the acute and long-term outcome of percutaneous coronary interventions even in patients with high risk or unstable haemodynamic conditions. On the basis of the haemodynamic situation, the outcomes of percutaneous interventions on protected and unprotected LM stenosis differ considerably: an unprotected LM stenosis paired with ischaemic syndromes always means a highly critical situ- ation that has to be resolved in a very short time. Both protected and unprotected LM stenoses can be the reason for stable and unstable coronary syndromes; however, myocardial ischaemia caused by an unprotected LM stenosis is generally more severe as it more often results in haemodynamic instability requiring emergency bypass surgery, or if an operation is not possible, an emergency percutaneous treatment. The results from percutaneous interventions of protected LM stenoses showed that this kind of treatment is technically easily feasible and associated with a low incidence of short-, mid- and long-term death, myocar- dial infarction or repeat revascularization (MACE). Elective interventions of unprotected LM stenoses also seem to be safe: short-, mid- and long-term follow-ups demonstrate an acceptably low rate of MACE. Although emergency percutaneous inter- ventions of both protected and unprotected LM disease lead to fairly good acute procedural success rates, a high in-hospital mortality with a further decrease in long-term event-free survival rate, but an acceptable mortality rate can be expected. J Clin Basic Cardiol 2002; 5: 163-9.01/2002;
- Journal of Anesthesia 03/1998; 12(1). · 1.12 Impact Factor
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ABSTRACT: We compared the angiographic and clinical outcomes after directional coronary atherectomy (DCA, 13 patients) with those after conventional balloon angioplasty (BA, 21 patients) in patients with protected left main coronary artery stenosis. The initial success rate was 100% in the DCA group and 81% (17 of 21) in the BA group. Restenosis was present in 2 of 11 patients in the DCA group and 9 of 16 patients in the BA group (18% vs. 56%, P < 0.05). DCA and BA improved a minimal lumen diameter. The initial gain after DCA was greater than that after BA. At follow-up, the minimal lumen diameter was larger and the percentage diameter stenosis was smaller in the DCA group than in the BA group. The late loss and loss index were equivalent in both groups. Compared with conventional BA, DCA in protected left main coronary artery stenosis is associated with a higher angiographic success rate and provides a wider luminal diameter with reduced incidence of restenosis. Cathet. Cardiovasc. Diagn. 44:138–141, 1998. © 1998 Wiley-Liss, Inc.Catheterization and Cardiovascular Diagnosis 12/1998; 44(2):138 - 141.