title: Sirolimus-eluting stent treatment for complex proximal left anterior descending artery stenoses: 7-month clinical and angiographic results.
abstract: BACKGROUND
  High-grade involvement of the proximal left anterior descending artery (LAD), either in isolation or as part of multivessel coronary artery disease, remains a frequent indication for surgical revascularization. This is particularly true in complex proximal LAD lesions among high-risk patients, since stenting is usually ineffective in the long term as regards freedom from angina and target vessel revascularization (TVR) in such patient subsets. The sirolimus-eluting stent (SES) has been reported to significantly reduce clinical and angiographic restenosis rates. We therefore analyzed the clinical and angiographic long-term results of a group of complex patients treated with SES for proximal LAD stenoses.
  
  
  METHODS
  A total of 80 consecutive patients treated with sirolimus-eluting stents (SES) for complex proximal LAD stenoses were analyzed. This high-risk cohort included diabetic patients, long, bifurcated, ostial and heavily calcified lesions, chronic total occlusions and in-stent restenoses. Late lumen loss and clinically-driven target lesion revascularization (TLR) were analyzed at 7 months.
  
  
  RESULTS
  Late lumen loss was 0.19 +/- 0.06 mm in the analysis segment (stent with 5 mm proximal and distal to it) at 7 months. TLR was performed in 6.3% of cases, and the combined rate of death from any cause, nonfatal MI and TLR was also 6.3% at 7 months.
  
  
  CONCLUSIONS
  SES, once successfully implanted into complex proximal LAD stenoses, appear effective, with rather acceptable rates of adverse events at 7-month follow-up. Accordingly, treating the proximal LAD using SES in complex patients may narrow the gap between PCI and surgery for this indication.
authors.affiliation: Heart Centre Segeberger Kliniken GmbH, Bad Segeberg, Germany.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Andreas
authors.initials: A
authors.lastname: Otto
authors.forename: Ralph
authors.initials: R
authors.lastname: Toelg
authors.forename: Volker
authors.initials: V
authors.lastname: Geist
authors.forename: Lothar
authors.initials: L
authors.lastname: Klatt
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control; D023921:Coronary Stenosis / Q000188:drug therapy / Q000628:therapy*; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus