Samir Rafla
Alexandria University, Egypt
Title: Stenting unprotected left main coronary without assisting imaging techniques is feasible
Biography
Biography: Samir Rafla
Abstract
Background: Guidelines allow stenting of unprotected left main coronary artery (LMCA) under special circumstances. Our study evaluated this subject without the utilization of IVUS. Methods: 120 patients with LMCA disease >50%. Exclusion criteria were Syntax score > 32 unless denied by the surgeon, cardiogenic shock and mechanically ventilated patients, patients with valvular heart disease requiring valve intervention, platelet count < 100000 or greater than 700000, or hemoglobin <10 g; recent major bleeding or current warfarin use; history of ischemic stroke within 6 months; patients with chronic total occlusion of a major epicardial vessel. The femoral approach in 101, radial in 19. LM stent type Xience Xpedition/ Alpine/V/Prime in 76 patients, in the remaining patients, other types of drug eluted stents were inserted. Results: 88 male patients and 32 females, mean age 61 years. 79% were diabetic, 69% hypertensive, 57% were current smokers, 50% were dyslipidemic.
Clinical presentation: 77% presented with acute coronary syndrome, 22.7% of them had previous PCI, one patient with previous CABG. 22.7% had chronic coronary syndrome (none of them had previous intervention). Angiographic (anatomical) characteristics: Distal lesion in 101 patients (94 bifurcation, 7 trifurcation), non-distal in 19. Ostial LCX significant disease in 50, none significant in 70. Bifurcation angle >70 in 28, < 70 i8n 92. Number of diseased vessels one in 19 patients, two in 65, three in 36. Presence of calcification in 55 patients.
Presence of thrombi in 39. RCA lesion in 29 patients. Medina classification (distal LM) 1.0.0 in 11; 0.1.0 in 0; 1.1.0 in 33; 0.0.1 in 0; 1,0,1 in 12; 0.1.1 in 0; 1,1,1 in 45 patients. Syntax score < 23 in 17 patients; 23-32 in 73; >32 in 29 patients. Residual Syntax < 0-24 + 6. Complications: Access hematoma 8 (6.6%), PCI dissection 2 (1.66%). CIN (Contrast Induced Nephropathy) in 3 (2.5%); Heart Failure in 7 (5.8%). Mortality none. CABG referral none. Follow up for 6 months: Death 2 (1.7%), non-fatal ACS 6 (5%), stroke 1 (0.8%). Conclusions: PCI in unprotected left main coronary artery disease is a safe and feasible option with a high technical success rate and acceptable outcome in follow-up. Risk stratification is critical for strategy selection in the management of LMCAD patients. The absence of Assisting imaging techniques namely IVUS is not prohibitive in this contest despite its valuable role in stent optimization.