Left main coronary artery disease

DeMots, Henry; Bonchek, Lawrence I.; Rösch, Josef; Anderson, Richard P.; Starr, Albert; Rahimtoola, Shahbudin H.

doi:10.1016/0002-9149(75)90516-0

Cited by 128 publications

(40 citation statements)

References 15 publications

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“…Left main coronary artery disease (LMCD: >50% diameter stenosis), is identified in 5-7% of patients undergoing coronary angiography [61,62] and poses significant management issues due to the extensive territory that is at risk during revascularisation. CABG has been the gold standard treatment for LMCD for nearly three decades and is still recommended as the most appropriate revascularisation technique in the 2010 European Society of Cardiology Guidelines [44,63].…”

Section: Left Main Coronary Artery Diseasementioning

confidence: 99%

Off-pump Coronary Artery Bypass Grafting in Elderly and High-risk Patients – A Review

Cooper

Edelman

Wilson

et al. 2011

Heart, Lung and Circulation

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Section: Left Main Coronary Artery Diseasementioning

confidence: 99%

Off-pump Coronary Artery Bypass Grafting in Elderly and High-risk Patients – A Review

Cooper

Edelman

Wilson

et al. 2011

Heart, Lung and Circulation

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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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“…40 Over the past decade, stenting of the left main has been utilized in cases of LMND to avert the need for CABG in patients with significant comorbidities. The main risk with unprotected left main stenting is the expected occurrence of stent-related complications including dissection, thrombosis, and in-stent stenosis.…”

Section: Left Main Disease Prior To Major Vascular Surgerymentioning

confidence: 99%

Preoperative Cardiac Evaluation of the Vascular Surgery Patient—An Anesthesia Perspective

Omar

Mangar²,

Camporesi

2012

Vasc Endovascular Surg

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The morbidity and mortality associated with vascular surgery procedures are largely the results of cardiac events. National guidelines have been regularly proposed and updated by the American College of Cardiology (ACC)/American Heart Association (AHA) to ensure optimal perioperative management and risk stratification. Controversy remains between experts and other cardiology societies regarding several patient care issues including revascularization before surgery, timing of b-blocker therapy, and the administration of antiplatelet therapy. Several landmark articles recently published have helped to modify the guidelines in the hope of improving vascular patient outcomes. In this review, we searched all recent available literature pertaining to perioperative cardiac evaluation before major vascular surgery. We propose an algorithm for preoperative cardiac evaluation, which is a modification to the AHA recommendations. Incorporated in this algorithm are recent published pivotal articles that can help in guiding physicians caring for the vascular patient requiring major operative or endovascular interventions.

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Left main coronary artery disease

Cited by 128 publications

References 15 publications

Off-pump Coronary Artery Bypass Grafting in Elderly and High-risk Patients – A Review

Off-pump Coronary Artery Bypass Grafting in Elderly and High-risk Patients – A Review

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

Preoperative Cardiac Evaluation of the Vascular Surgery Patient—An Anesthesia Perspective

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