title: Stenting of the unprotected left main coronary artery in patients with severe aortic stenosis prior to percutaneous valve interventions.
abstract: OBJECTIVE
  High-risk patients with severe aortic stenosis (AS) who are candidates for transcatheter valve implantation (TAVI) or balloon aortic valvuloplasty (BAV) may additionally require revascularization of the unprotected left main coronary artery (UPLM). We aimed to assess the feasibility and procedural safety of UPLM stenting in such patients.
  
  
  RESULTS
  Ten cases of UPLM stenting prior to BAV or TAVI at three medical centers over a 2-year period were identified. Mean age was 84±4 years, aortic valve area was 0.70±0.12 cm(2), left ventricular ejection fraction was 58%±3%, and logistic EuroScore was 32±17. Intraaortic balloon counterpulsation was used in three patients. A single stent was used in seven patients, and two stents were used in three patients. One patient received a bare-metal stent, and the others received drug-eluting stents. No procedural complications occurred, and the patients were hemodynamically stable. Three patients subsequently underwent BAV, and seven underwent TAVI. During 6 months of follow-up, two patients died: one due to AS restenosis 6 months after BAV and one due to vascular complications 18 days after TAVI (34 days after UPLM stenting).
  
  
  CONCLUSIONS
  Stenting of the UPLM in patients with severe AS prior to percutaneous valve intervention seems feasible and safe. This approach may enable more patients to achieve comprehensive percutaneous therapy for severe coronary and valvular disease.
authors.affiliation: Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, 7 Michal Street, Haifa, Israel. jaffe@clalit.org.il
authors.forename: Ronen
authors.initials: R
authors.lastname: Jaffe
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
authors.forename: Victor
authors.initials: V
authors.lastname: Guetta
authors.forename: Nader
authors.initials: N
authors.lastname: Khader
authors.forename: Ronen
authors.initials: R
authors.lastname: Rubinshtein
authors.forename: David A
authors.initials: DA
authors.lastname: Halon
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002404:Catheterization; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed