Expedited Review
Serial Angiographic Follow-Up of Sirolimus-Eluting Stents for Unprotected Left Main Coronary Artery Revascularization

https://doi.org/10.1016/j.jacc.2005.12.015Get rights and content
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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.

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

Cited by (0)

Dr. Moses is a consultant for and stock shareholder of Johnson & Johnson. Dr. Leon is a stock shareholder of Johnson & Johnson. Dr. Lansky receives research grants from Johnson & Johnson. Dr. Teirstein receives royalties and research grants from Johnson & Johnson.