Emergency coronary stenting for acute occlusive dissection of the left main coronary artery

García-Robles, José Antonio; Garcı́a, Eulogio; Rico, Mariano; Esteban, Elena; Prado, Armando Pérez de; Delcán, Juan L.

doi:10.1002/ccd.1810300310

Cited by 45 publications

(17 citation statements)

References 11 publications

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“…However, recently some reports have begun to appear in the literature concerning stenting of unprotected LMCA disease in patients with very high surgical risks or severe comorbid conditions. [19][20][21] For this reason, this technique has been shown to be highly effective in preventing elastic recoil and abrupt vessel closure, thereby improving the acute result of PTCA. In our study, stent implan-tation was performed in 5 patients and successful left coronary artery dilatation was achieved in all patients.…”

Section: -13)mentioning

confidence: 99%

Factors Predicting Mortality in Patients after Myocardial Infarction Caused by Left Main Coronary Artery Occlusion. Significance of ST Segment Elevation in Both aVR and aVL Leads.

et al. 2000

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SUMMARYAcute left main coronary artery obstruction is rare and most patients in this clinical setting die of sudden death or cardiogenic shock. During the past 8 years, we encountered 13 patients with acute myocardial infarction caused by total occlusion of the left main coronary artery (LMCA-AMI). Thus, we surveyed these patients, and attempted to elucidate helpful predictors related to the prognosis. Six of 13 patients with LMCA-AMI survived. Successful left coronary artery dilatation was achieved in all survivors (group S), and in 5 (71%) non-survivors (group non-S). The age was not different between the two groups. A past history of angina was confirmed in 83% of group S, while only in 29% of group non-S. Clinical findings such as time of onset of AMI, interval from the AMI onset to admission, elapsed period from the AMI onset to recanalization of LMCA and the value of CK on admission were not different between the two groups. However, cardiogenic shock occurred in only 1 patient (17%) in group S compared with 5 patients (71%) in group non-S. As emphasized in the literature, good collateral circulation to the left anterior descending artery was observed in 5 patients (83%) in group S, while not observed in group non-S. Electro cardiographically, ST elevation in the aVR lead was very characteristic. This finding was confirmed in 69% of the total patients. Noticeably, 5 out of 6 non-survivors (83%) showed ST elevation not only in leads aVR but also in the aVL lead. In addition to the absence of collateral circulation, this electrocardiographic finding, which obviously indicates the presence of extensive myocardial ischemia in the diseased heart, is a simple and important predictor suggesting a poor prognosis in LMCA-AMI patients. (Jpn Heart J 2000; 41: 571-581) Key words: Total occlusion of the left main coronary artery, Acute myocardial infarction, Prognosis, ST elevation in aVR and aVL leads DUE to the increasing development of cardiac emergency systems including the Coronary Care Unit (CCU) and also early revascularization therapy such as per-

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Section: -13)mentioning

confidence: 99%

Factors Predicting Mortality in Patients after Myocardial Infarction Caused by Left Main Coronary Artery Occlusion. Significance of ST Segment Elevation in Both aVR and aVL Leads.

et al. 2000

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“…This is exemplified by the results of one of the largest series of LMCA angioplasty, in which O'Keefe et al [6] reported a 9.1% procedural mortality and a 3-year survival rate of only 36% in unprotected left main stenosis, against 2.4% and 90%, respectively, in protected ones. With the availability of the Palmaz-Schatz coronary stent in the early 1990s, cardiologists began to use this device for treatment of unprotected LMCA disease, usually as a bailout in acute left main dissection [11,12] or as an alternative to CABG in patients with high surgical risk or severe comorbid conditions [13]. Despite the reported successes, there remain three main concerns in stenting of unprotected LMCA stenosis: acute safety, technical difficulties, and long-term clinical results of the procedure.…”

Section: Discussionmentioning

confidence: 98%

“…It has also been shown in randomized trials to reduce restenosis compared with balloon angioplasty [9,10]. Anecdotal reports began to appear in the literature about stenting of unprotected LMCA disease, either as a bailout procedure or as a compassionate alternative in patients with very high surgical risks or severe comorbid conditions [11][12][13]. The LMCA, however, has a unique anatomy.…”

Section: Introductionmentioning

confidence: 97%

A prospective study of elective stenting in unprotected left main coronary disease

Wong

Tse

et al. 1999

Cathet. Cardiovasc. Intervent.

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“…[2][3][4][5]11 In the present study, all patients with LMCA dissection were successfully treated with stent deployment. Treatment options for this complication include intracoronary stenting and emergency CABG.…”

Section: Discussionmentioning

confidence: 99%

“…In this circumstance, stent implantation could be the fastest technique in achieving vessel patency and stabilizing hemodynamic status. [2][3][4][5] We therefore assumed that prompt stent implantation for LMCA dissection is safe and associated with favorable clinical outcome. To test this hypothesis, we retrospectively evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during a catheter-based procedure.…”

Section: Introductionmentioning

confidence: 99%

Bail‐out stenting for left main coronary artery dissection during catheter‐based procedure: Acute and long‐term results

Lee

Hong

Kim

et al. 2004

Clinical Cardiology

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SummaryBackground: The optimal treatment of patients with left main coronary artery (LMCA) dissection during catheterbased procedure remains uncertain.Hypothesis: In cases with significant LMCA dissection occurring during catheter-based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome.Methods: We evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during a catheter-based procedure in 10 patients.Results: Initially, there was no significant stenosis of LMCA segments in these patients. Catheter-induced dissection occurred in eight patients (during diagnostic angiography in three patients and during guiding catheter manipulation in five patients). Two patients suffered dissection in the setting of stent deployment in other vessels. Therefore, bail-out stenting for LMCA dissection was performed in a total of 10 patients. In four patients, hypotension developed and an intra-aortic balloon pump was placed during the procedure. Stents were successfully deployed in all patients; there was no in-hospital mortality. Six-month angiographic follow-up was performed

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Emergency coronary stenting for acute occlusive dissection of the left main coronary artery

Cited by 45 publications

References 11 publications

Factors Predicting Mortality in Patients after Myocardial Infarction Caused by Left Main Coronary Artery Occlusion. Significance of ST Segment Elevation in Both aVR and aVL Leads.

Factors Predicting Mortality in Patients after Myocardial Infarction Caused by Left Main Coronary Artery Occlusion. Significance of ST Segment Elevation in Both aVR and aVL Leads.

A prospective study of elective stenting in unprotected left main coronary disease

Bail‐out stenting for left main coronary artery dissection during catheter‐based procedure: Acute and long‐term results

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