title: Rapamycin-eluting stents for the treatment of unprotected left main coronary disease.
abstract: BACKGROUND
  Conventional bare stents have been used to treat unprotected left main (LM) coronary artery stenosis. However, restenosis remains the main limitation. Since rapamycin-eluting stents (RES) appear to inhibit neointimal proliferation, their application to this specific site seems promising.
  
  
  METHODS
  Since May 2002, we have studied a series of 52 patients with LM lesions treated with RES. Forty-seven patients presented with de novo stenoses, and 5 had in-stent restenosis; 19 patients required combined stent treatment for other remote lesions in the coronary tree, 6 of them at the level of proximal right coronary artery. The RES was implanted directly at the LM in 39 patients; 13 others needed predilation. Once deployed, the RES was overexpanded with short balloons adjusted to the LM length in 44 patients. Quantitative coronary angiograms were analyzed in the same view before and immediately after treatment and at follow-up. Patients were followed-up closely and new cardiac catheterization was scheduled at 6-month evaluation or earlier in the presence of symptoms. At follow-up study, quantitative coronary angiography and motorized intravascular ultrasound analyses were performed in 35 (67%) patients.
  
  
  RESULTS
  Primary success was obtained in 50 patients (96%). Two patients (4%) developed a non-Q-wave myocardial infarction. All patients were symptom-free at discharge. After a mean follow-up of 12 +/- 4 months, 50 patients (96%) remain asymptomatic. No late death or acute thrombosis have been recorded. Two patients became symptomatic 2 and 4 months after treatment, respectively. One had restenosis at a remote site, while the other had in-segment restenosis. None of the remaining 33 angiographically evaluated patients developed restenosis at any site. Target lesion revascularization was 1/52 (2%).
  
  
  CONCLUSIONS
  Although longer-term follow-up studies are needed, the tailored treatment of coronary lesions located at the LM by overexpanded RES is feasible and safe. Midterm results seem promising, which might help to shift the orientation of patient management from surgical to percutaneous revascularization.
authors.affiliation: Reina Sofia Hospital, University of Córdoba, Cordoba, Spain. grupo_corpal@arrakis.es
authors.forename: Jose Suarez
authors.initials: JS
authors.lastname: de Lezo
authors.forename: Alfonso
authors.initials: A
authors.lastname: Medina
authors.forename: Manuel
authors.initials: M
authors.lastname: Pan
authors.forename: Antonio
authors.initials: A
authors.lastname: Delgado
authors.forename: José
authors.initials: J
authors.lastname: Segura
authors.forename: Djordje
authors.initials: D
authors.lastname: Pavlovic
authors.forename: Francisco
authors.initials: F
authors.lastname: Melián
authors.forename: Miguel
authors.initials: M
authors.lastname: Romero
authors.forename: Luis
authors.initials: L
authors.lastname: Burgos
authors.forename: Enrique
authors.initials: E
authors.lastname: Hernández
authors.forename: Isabel
authors.initials: I
authors.lastname: Ureña
authors.forename: Juan
authors.initials: J
authors.lastname: Herrador
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D020123:Sirolimus / Q000627:therapeutic use*; D015607:Stents; D018084:Ultrasonography, Interventional
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus