Isolated coronary ostial stenosis

Miller, Graham; Honey, M; El‐Sayed, Hassan

doi:10.1002/ccd.1810120108

Cited by 55 publications

(26 citation statements)

References 10 publications

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“…2,3 Isolated LMCA disease is very rare, only 0.07-0.15% in CAG patients. [4][5][6] Patients with significant LMCA stenosis who are on medical treatment, have a poor prognosis; three-year survival rate ranges from 60-82% 7,8 , and 15-year survival rate was 27% 9 .…”

Section: Discussion: Introduction and Epidemiologymentioning

confidence: 99%

Percutaneous Coronary Intervention in Left Main Coronary Artery Disease - A Case Report

Chowdhury¹,

Uddin

Khalequzzaman

et al. 2012

Univ. Heart J.

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Left main coronary artery (LMCA) atherosclerosis bears extra importance because of the large territory of myocardium supplied by the vessel. By convention, significant LMCA stenosis is treated by coronary artery bypass graft (CABG) surgery, and this type of lesion has long been regarded as a contraindication for percutaneous coronary intervention (PCI). However, with the advancement in interventional tools, operators' expertise, pharmaceuticals and supportive measures, outlook regarding left main PCI is changing. Recent clinical trials tell about the feasibility of LMCA PCI. The three cases of significant left main lesion presented here, were treated successfully by percutaneous transluminal coronary angioplasty (PTCA) with stenting in National Institute of Cardiovascular Diseases (NICVD), Dhaka. In near future, PCI may be an equally effective alternative to surgical revascularization in judiciously selected cases of LMCA stenosis even in Bangladesh. Case 1:Mr. AB, a 43-year-old smoker, who was hypertensive but non-diabetic, was admitted into NICVD, Dhaka. Two weeks back, he was treated as a case of unstable angina in Chittagong Medical College Hospital (CMCH). Coronary angiography (CAG) done in Chittagong Medical College Hospital (CMCH) revealed severe left main coronary artery (LMCA) disease with 70-80% stenosis at its mid part, for which he was referred to NICVD for further management. His resting ECG showed ST depression in lead II, III, AVF, V 5 and V 6 ; echocardiography disclosed septal and inferior left ventricular wall hypokinesia with left ventricular ejection fraction (LVEF) 54%. Blood counts and biochemistry including sugar, creatinine and lipid profile were normal. Serological tests i.e. HBsAg, Anti-HCV, Anti-HIV, VDRL were negative. PTCA and stenting to LMCA was done uneventfully. The LMCA lesion was negotiated with floppy PTCA guidewire, and a 3.0x10 mm cobultchromium stent was deployed at the lesion at 14 atm pressure, preceded by dilatation with a 1.5x6 mm balloon at 8 atm. TIMI III flow was established (Fig. 1). Postprocedural period was uneventful. An anesthesiologist was constantly present in the cath lab and a full coronary artery bypass graft (CABG) team was kept ready for emergency revascularization surgery, if needed. Case 2:Mr. AK, a 38-year-old normotensive, nondiabetic but dyslipidaemic man, with a strong family history of coronary artery disease, presented to NICVD with compressive chest pain. He was haemodynamically stable with pulse 80 beats per minute, blood pressure 120/75 mm Hg, lung bases were clear and heart sounds were

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Section: Discussion: Introduction and Epidemiologymentioning

confidence: 99%

Percutaneous Coronary Intervention in Left Main Coronary Artery Disease - A Case Report

Chowdhury¹,

Uddin

Khalequzzaman

et al. 2012

Univ. Heart J.

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“…8)9) In contrast, an isolated significant atherosclerotic lesion of the left main coronary artery is rare, with reported incidences of 0.15% and 0.07% for all the patients who underwent angiography. [10][11][12] It is widely accepted that coronary artery disease with greater than 50% left main coronary artery stenosis is a strong indication for early CABG. Many previous studies over the last several years have reported on the safety and feasibility of LMCA stenting.…”

Section: Discussionmentioning

confidence: 99%

Lesion Location: Its Impacts on the Procedural and Postprocedural Outcomes of Unprotected Left Main Coronary Stenting

Kim

Lee

et al. 2007

Korean Circ J

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Background and Objectives：Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) stenosis is a promising technique in the drug-eluting stent era. However, there is a lack of data as to the impact of the lesion location in the LMCA on the procedural and postprocedural outcomes. The aim of this study is to evaluate the effect of lesion location on the procedural and postprocedural outcomes. Subjects and Methods： From July 2003 to January 2006, we enrolled 82 patients (Males: n=49), who underwent PCI for unprotected LMCA stenosis at Yeungnam University Medical Center, Keimyung University Dong-san Hospital and In-je University Baik Hospital in Busan. The patients were divided into two groups according to the lesion location. Group 1 (n= 38) was defined as those patients who had a significant stenosis in the ostium and/or body. Group 2 (n=44) was defined as those patients had a left main coronary lesion involving a bifurcation. All the patients had a sirolimus eluting stent (Cypher, Cordis) deployed into the LMCA stenosis. Stenting techniques such as the T, crush and kissing stent techniques for treating the LMCA were used at the discretion of the operator and according to the characteristics of the lesion location. The in-hospital outcomes were compared between the two groups and followup coronary angiography was performed after 6 months; the major adverse cardiac events (MACE) and restenosis were analyzed between the two groups. Results：The baseline characteristics between the two groups were not statistically different. The procedural outcomes showed that for the stenting methods, the conventional stent technique was the only one used in all cases of Group 1, but the kissing, T stenting and Crush techniques were also used in Group 2 (p=0.001). The clinical outcomes showed that that there was no statistical difference for the in-hospital MACEs between the two groups, but for the out-of hospital MACEs at 6 month, the target lesion revascularizatin rates, including PCI or bypass graft operation, in Group 1 were higher than those in Group 2 (0% vs 13.6%, respectively p=0.043). Both groups had one cardiac death each (2.3% vs 2.6% respectively) and there was 1 MACE in Group 1 and 7 MACEs in Group 2 (2.6% vs 16%, respectively, p=0.045). The angiographic outcomes at 6 month showed that all 8 significant restenosis cases were included in Group 2 (18%, 9.7% in the total population); the restenosis site was the left circumflex artery in all cases. Conclusion：PCI with using drug eluting stents in the left main lesion showed favorable short term outcomes in selected patients. The lesion location is also an important factor for the clinical and angiographical outcomes.

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“…Isolated coronary ostial stenosis is a rare condition and generally results from primary atherosclerotic involvement of the aorta rather than the coronary artery itself. In most angiographic series, the prevalence of isolated coronary ostial stenosis ranges from 0.1% to 0.9% [3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%