Elective stenting of unprotected left main coronary artery stenosis: Effect of debulking before stenting and intravascular ultrasound guidance

Seung Jung Park, Myeong Ki Hong, Cheol Whan Lee, Jae Joong Kim, Jae Kwan Song, Duk Hyun Kang, Seong Wook Park, Gary S. Mintz

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165 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1054-1060
Number of pages7
JournalJournal of the American College of Cardiology
Volume38
Issue number4
DOIs
Publication statusPublished - 2001

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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