Serial angiographic follow-up of sirolimus-eluting stents for unprotected left main coronary artery revascularization.
OBJECTIVE
This study was performed to evaluate the clinical and serial angiographic outcomes of patients undergoing sirolimus-eluting stent (SES) implantation for unprotected left main coronary artery (LMCA) stenosis.


BACKGROUND
The efficacy of SES has led to their expanded use for off-label indications, including LMCA disease.


METHODS
Unprotected LMCA intervention with SES was attempted in 50 patients. Surveillance angiography was performed at three and nine months' follow-up.


RESULTS
The target lesion involved the distal LMCA in 47 patients (94%). In-lesion restenosis occurred in 21 patients (42%), was focal in 85% of cases, and in 82% involved the branch ostia, sparing the LMCA itself. Target lesion revascularization (TLR) occurred in 19 patients (38%) over a mean follow-up of 276 +/- 57 days; TLR was ischemia-driven in 7 patients (14%). Late loss was significantly greater within the left circumflex (LCX) ostium compared to the parent vessel (PV) of the LMCA bifurcation (0.83 +/- 0.89 mm vs. 0.49 +/- 0.72 mm, p = 0.04). Late loss continued to increase between three- and nine-month follow-up. Final minimal luminal diameter and maximal balloon pressure were independent predictors of restenosis of the PV.


CONCLUSIONS
Restenosis is a frequent finding when serial angiographic follow-up is performed after SES implantation for unprotected distal LMCA lesions. Restenosis is usually focal, most often involves the LCX ostium, and often occurs without symptoms.
Division of Cardiovascular Disease, Scripps Clinic, La Jolla, California 92037, USA.
Matthew J
MJ
Price
Ecaterina
E
Cristea
Neil
N
Sawhney
John A
JA
Kao
Jeffrey W
JW
Moses
Martin B
MB
Leon
Ricardo A
RA
Costa
Alexandra J
AJ
Lansky
Paul S
PS
Teirstein
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002318:Cardiovascular Diseases / Q000401:mortality; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents
D020123:Sirolimus