Drug-eluting stents for the percutaneous treatment of the anastomosis of the left internal mammary graft to left anterior descending artery.
BACKGROUND
Data on the treatment of left internal mammary to left anterior descending artery (LIMA-to-LAD) anastomotic disease are scarce and not homogeneous. Both surgery and percutaneous interventions (PCI) have been attempted, but the most effective treatment has not yet been established. In particular, should PCI be performed, the role of stenting seems to be limited by less favorable results than in other subsets of lesions.


OBJECTIVE
To assess the clinical impact of drug-eluting stent (DES) use in this particular subset of lesions.


METHODS
We describe a cohort of patients treated with PCI on LIMA-to-LAD anastomoses, reporting acute 1-year clinical and angiographic outcomes. The clinical impact of DES use was evaluated as the requirement for target lesion revascularizations (TLR).


RESULTS
Fifty-six consecutive patients were evaluated. Acute procedural success was achieved in 52 patients (92.8%). Plain balloon angioplasty allowed acute procedural success in 15 patients (28.8%), whereas stenting was required in 37 patients (71.2%) with suboptimal results or to treat complications. Bare-metal stents (BMS) were used in 17 and DES in 20 patients, without differences in acute results. One-year clinical follow-up was available in 96.1% of patients. TLR were needed in 17.3% of patients. No significant differences were detected in TLR rates after treatment with BMS and DES (26.6% vs. 25%; P=0.99). Two late stent thromboses were observed after DES deployment.


CONCLUSIONS
PCI of the stenoses of LIMA-to-LAD anastomoses with DES did not provide any clinical improvement over BMS use in long-term outcomes; DES use was associated with some cases of late thrombosis.
Zavalloni
Dennis
D
Invasive Cardiology Department, Istituto Clinico Humanitas, IRCCS, Rozzano (Milano), Italy. dennis.zavalloni_parenti@humanitas.it
Rossi
Marco L
ML
Scatturin
Melania
M
Morenghi
Emanuela
E
Soregaroli
Daniela
D
Municino
Annamaria
A
Gasparini
Gabriele L
GL
Lisignoli
Veronica
V
Barbaro
Cristina
C
Presbitero
Patrizia
P
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome