Author + information
- Maddury Jyotsna,
- Nageswara Rao Sureddi,
- Jahangeer Basha Shaik,
- Subramanyam P.S.S and
- Lalita Nemani
Percutaneous coronary intervention (PCI) is a potential alternative to bypass surgery for patients with unprotected left main (LM) coronary artery stenosis. However, PCI for LM bifurcation is technically demanding and has been associated with high rates of adverse clinical events. Randomized clinical trials focusing on distal LM intervention regarding the optimal stenting strategy are lacking. In general, the provisional one-stent approach has been considered as a preferred strategy over the elective two-stent technique for patients with LM bifurcation disease.
To report the post angioplasty profile of single-stenting technique from distal unprotected left main coronary artery (LMCA) to Major side branch.
Material and Methods
We have retrospectively analyzed the data of patients with Distal LMCA bifurcation lesions presented to the Nizam’s Institute of Medical Sciences, Hyderabad, India between 2010 to 2013 who underwent intervention with single stent crossover technique to distal unprotected LMCA.
A total of 83 patients underwent distal LMCA intervention, LMCA-LCX in 35 patients (42%) and LMCA-LAD in 48 patients (58%). 75 patients (90 %) had significant side branch disease and in all both branches were wired. Post stenting of the main vessel only 12 patients (13%) required treatment to side branch (stenting in 7 patients & balloon in remaining 5) due to TIMI 2 flow. The bifurcation angle ranged from min 45 degrees to max 170 degrees, however only 3 patients required final kissing balloon technique. Post PCI all patients had TIMI-III flow in both the vessels.
In distal LMCA bifurcation lesions, LMCA to main vessel stenting can be performed safely with conventional single stenting technique irrespective of the presence of significant side vessel disease across wide range of main vessel angulations with good end result. It may therefore be important to evaluate alternative strategies for treating distal LMCA bifurcation disease.