title: Single-stent crossover technique from distal unprotected left main coronary artery to the left circumflex artery.
abstract: OBJECTIVE
  To report the clinical outcomes of single-stenting from distal unprotected left main coronary artery (LMCA) to the left circumflex artery (LCx).
  
  
  BACKGROUND
  Percutaneous coronary intervention of distal LMCA is usually performed by stenting into the left anterior descending artery (LAD). In some cases, stenting from LMCA to LCx alone is performed.
  
  
  METHODS
  Between April 2002 and April 2011, single-stenting with drug-eluting stents for distal unprotected LMCA disease was performed in 584 patients. Thirty-one patients underwent LMCA-LCx stenting, who were compared with the remaining 553 LMCA-LAD stented patients.
  
  
  RESULTS
  At 3-year follow-up, there were no significant differences between LMCA-LCx and LMCA-LAD stenting groups in major adverse cardiac events (24.1% vs. 19.6%; P = 0.540), cardiac death, and myocardial infarction. A trend toward higher target lesion revascularization (TLR) in the LMCA-LCx stenting group was noted. This was significant when the stented branch was only considered (18.2% vs. 3.0%; P < 0.001). In both TLR subgroups, LCx ostium was frequently involved (83.3% in LMCA-LCx vs. 66.2% in LMCA-LAD TLR subgroups; P = 0.39). The LAD ostium was more frequently involved in LMCA-LCx TLR subgroup (83.3% vs. 21.0%; P < 0.001). On the multivariable Cox regression analysis, LMCA-LCx stenting was an independent predictor of TLR for restenosis at the ostium of the stented branch (HR 6.49; 95% CI 2.27-18.53; P < 0.001).
  
  
  CONCLUSIONS
  TLR rate at the LCx ostium is high irrespective of LMCA-LCx or LMCA-LAD stenting. The former also seems to be associated with high TLR at the LAD ostium. It may therefore be important to evaluate alternative strategies for treating distal LMCA disease that extends into the LCx but not LAD.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Sandeep
authors.initials: S
authors.lastname: Basavarajaiah
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Chiara
authors.initials: C
authors.lastname: Bernelli
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary bifurcation; drug-eluting stent; left main coronary disease