title: Long-term outcomes in treating left main trifurcation coronary artery disease with the Paclitaxel-eluting stent.
abstract: BACKGROUND
  Left main trifurcation coronary artery disease stenting is a challenging and complex percutaneous procedure that has been infrequently reported. We present our own experience with left main trifurcation stenting using the Taxus paclitaxel-eluting stent (Boston Scientific).
  
  
  METHODS
  Twenty consecutive left main trifurcation stenting procedures were performed in 2005 at our institution. The primary endpoint of the study was the combined endpoints of death, acute stent thrombosis and target lesion revascularization (TLR). Conditional logistic regression analysis was performed to determine the predictors of the primary endpoint using a number of variable combinations.
  
  
  RESULTS
  The mean patient age was 71.7 +/- 8.9 years. The procedure was urgent in 10%, and the left main artery was unprotected in 95% of cases. Follow up was achieved in 17/20 (85%) patients, either from medical records or by phone calls. The follow-up median duration was 272 days (range 30 to 534 days). The primary endpoint was met in 5/17 (29.4%) patients. One of 19 patients (5.3%) had a sudden cardiac death 1 month after the procedure, 2/20 patients (10%) experienced an acute in-hospital stent thrombosis, and 2/17 (11.8%) patients underwent TLR. Conditional logistic regression analysis could not identify a relationship between the stenting method and the primary endpoint. The 2 patients who experienced in-hospital thrombosis were the only patients who received a clopidogrel load (600 mg) post-procedure after arrival to the floor, and were not on a glycoprotein IIb/IIIa inhibitor. All others received their clopidogrel either during the procedure (n = 7) or were on it chronically (n = 11). One patient with acute stent thrombosis did not have a kissing balloon performed post-stent deployment.
  
  
  CONCLUSIONS
  Left main trifurcation stenting carries an overall high rate of adverse events and may need to be reserved for patients who are at high risk or who refuse bypass surgery. Overall TLR is low, but stent thrombosis remains a concern. Although we suspect that thrombosis could be related to failure to perform kissing balloon post-stent deployment and/or not receiving a clopidogrel load until after the procedure, the small number of patients in this study prevents us from making definite statistical conclusions about this observation.
authors.affiliation: Midwest Cardiovascular Research Foundation, Davenport, Iowa, USA.
authors.forename: Nicolas W
authors.initials: NW
authors.lastname: Shammas
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dippel
authors.forename: Amber
authors.initials: A
authors.lastname: Avila
authors.forename: Lauren
authors.initials: L
authors.lastname: Gehbauer
authors.forename: Leslie
authors.initials: L
authors.lastname: Farland
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brosius
authors.forename: Michael
authors.initials: M
authors.lastname: Jerin
authors.forename: Matthew
authors.initials: M
authors.lastname: Winter
authors.forename: Penny
authors.initials: P
authors.lastname: Stoakes
authors.forename: Jeannette
authors.initials: J
authors.lastname: Byrd
authors.forename: Lynne
authors.initials: L
authors.lastname: Majetic
authors.forename: Gail
authors.initials: G
authors.lastname: Shammas
authors.forename: Peter
authors.initials: P
authors.lastname: Sharis
authors.forename: Jon
authors.initials: J
authors.lastname: Robken
mesh_terms: D000368:Aged; D002404:Catheterization; D000077144:Clopidogrel; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage*
chemical_list: D010975:Platelet Aggregation Inhibitors; D050257:Tubulin Modulators; D000077144:Clopidogrel; D013988:Ticlopidine; D017239:Paclitaxel