Isolated left main coronary ostial stenosis in oriental people: Operative, histopathologic and clinical findings in six patients

Koh, Kwang Kon; Hwang, Hweung Kon; Kim, Pan Gum; Lee, Sang Hoon; Cho, Sang Kyoon; Kim, Sam Soo; Han, Jae Jin; Lee, Young Tak; Park, Pyo Won; Yoon, Dong Heon

doi:10.1016/0735-1097(93)90677-s

Cited by 35 publications

(27 citation statements)

References 19 publications

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“…In a study of IOS in Oriental patients, the clinical and pathohistological findings were similar to those reported in Western patients, but the incidence of IOS was higher in the Oriental group. 4 Those findings, including ours, suggest that the etiology of IOS in Oriental patients is not only related to atheroma, but also unknown to factors different from those in atheroma, and may be vasospasm and aortitis, for example. Morphological study of the ostium of the LMT shows that it is particularly well-defined and forms a funnel-shaped structure character- LMT, left main trunk; ITA, internal thoracic artery; ND, no data.…”

Section: Discussionmentioning

confidence: 88%

Long-Term Clinical and Angiographic Follow-up in Patients With Isolated Ostial Stenosis of the Left Coronary Artery

Arima

Kanoh

Okazaki

et al. 2009

Circ J

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solated ostial stenosis (IOS) of the left coronary artery (LCA), in the absence of distal vessel obstruction, is a rare form of coronary artery disease. It is neither associated with Takayasu arteritis, syphilitic aortitis, congenital anomaly, aortic valve disease nor iatrogenic cause such as mediastinal irradiation or cardiac surgery. Atherosclerosis, particularly early atheroma, has been considered its most likely cause, but its etiology is quite unknown. In such cases the occurrence has usually been in premenopausal women, 1 and the clinical profile might differ from that of the more common atherosclerotic stenosis of the left main trunk (LMT). 2 The clinical features of patients with IOS have gradually come to light, but the long-term prognosis and serial angiographic follow-up in patients with IOS who undergo coronary artery bypass grafting (CABG) have not been fully studied. Methods Study PopulationWe investigated 57 patients with stenosis of the LMT who underwent CABG. They underwent coronary angiography and subsequently treatment for myocardial ischemia before 1994. All patients underwent CABG at Juntendo University and were followed at Juntendo University Urayasu Hospital. They were categorized into 3 groups based on the angiographic findings: Group I comprised 9 patients with IOS ( Figure 1A); Group II comprised 12 patients with LCA ostial stenosis in the presence of distal vessel obstruction ( Figure 1B); Group III comprised 36 patients with stenosis of the LMT excluding ostial stenosis, and associated with distal vessel obstruction ( Figure 1C). We studied the coronary risk factors and prognosis in all patients. Hypercholesterolemia was defined as a requirement for antihyperlipidemic drugs or a total cholesterol (TC) level >220 mg/dl. Diabetes mellitus (DM) was defined as a requirement for therapy and/or with a fasting blood sugar >140 mg/dl, and/or a blood sugar >200 mg/dl on occasion. Baseline clinical and procedural data were collected for all patients. Coronary AngiographyThe patients underwent serial angiography at 1, 5, and 10 years after CABG, regardless of their symptoms, under informed consent. The films were of good quality and the repeat studies were always compared with the baseline coronary arteriogram. The films were read on 2 adjacent projectors by 2 angiographers working together to reach a consensus. The stenosis of the coronary arteries and grafts were defined as the linear percentage of narrowing of the diameter of the vessel compared with the diameter of the nearest normal segment. The severity of the stenosis was evaluated according to the American Heart Association Committee Report. In this study, graft patency was considered to be widely patent or the presence of stenosis <99% narrowing. In the follow-up angiography we studied the Long-Term Clinical and Angiographic Follow-up in Patients With Isolated Ostial Stenosis of the Left Coronary ArteryMizuhiro Arima, MD; Tatsuji Kanoh, MD*; Shinya Okazaki, MD*; Yoshitaka Iwama, MD*; Shigeru Matsuda, MD**; Yuji Nakazato, MD** Backgroun...

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Section: Discussionmentioning

confidence: 88%

Long-Term Clinical and Angiographic Follow-up in Patients With Isolated Ostial Stenosis of the Left Coronary Artery

Arima

Kanoh

Okazaki

et al. 2009

Circ J

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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%

Syphilitic aortitis

Cohen

Anderson

Navia

et al. 2001

Cathet. Cardiovasc. Intervent.

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“…'2 Ostial left main stem stenosis has been reported in patients with Takayasu disease, syphilitic aortitis, and aortic valve disease'3-'5 but none of the patients in the present study appeared to have these diseases. The predictive value of clinical markers is also low, although there is some evidence from retrospective studies that patients presenting with severe anginal symptoms (NYHA III), and low exercise tolerance [6][7][8][9][10][11][12][13][14][15][16][17][18][19] are more likely to have left main stem disease. Despite encouraging initial reports, neither transthoracic nor transoesophageal ultrasound imaging"222 nor magnetic resonance imaging"'25 can yet be regarded as routine techniques for non-invasive detection of left main stem disease.…”

Section: Discussionmentioning

confidence: 99%