title: Dual protection therapy with staged coronary artery bypass surgery and stenting in patients with left main coronary artery stenosis: long-term results from a single center.
abstract: OBJECTIVE
  We evaluated the efficacy and safety of dual protection therapy with staged coronary artery bypass grafting (CABG) and bare-metal stenting (BMS) in patients with left main coronary artery (LMCA) disease.
  
  
  BACKGROUND
  CABG is currently the preferred therapy for complex LMCA disease; however, the long-term patency rates of these grafts are unsatisfactory, and stenting alone for LMCA may be associated with the potentially fatal consequences of stent thrombosis or restenosis.
  
  
  METHODS
  Between January 1997 and October 2005, 42 patients underwent staged bypass surgery and BMS, with the latter procedure performed 2 weeks after the initial CABG. Of these patients, 40 received left internal mammary artery (LIMA) grafts, 34 saphenous vein grafts, 6 radial artery grafts, and 3 right IMA (RIMA) grafts. Minimally invasive bypass surgery was performed in 10 patients.
  
  
  RESULTS
  There were no operative complications. Forty-two stents were implanted in 42 lesions without complications. During the follow-up period of 135 ± 55 months, 1 patient died of cancer, 2 of cardiac causes, and 5 patients (12%) experienced target lesion revascularization. The target vessel failure rate was 24%. Forty patients (95%) underwent a 6-month angiographic follow-up. Restenosis was noted in 7 patients (18%). Reocclusion was also noted in 5 LIMA grafts, 5 saphenous vein grafts, 1 radial artery graft, and 1 RIMA graft. Only 1 patient experienced both restenosis of LM stenting and total occlusion of the 2 bypass grafts.
  
  
  CONCLUSIONS
  Dual protection therapy with staged CABG and stenting is not an appropriate therapeutic strategy because of unacceptable graft patency rate. A higher occlusive rate of the bypass grafts may result from decreased blood flow because of competing blood flow between the bypass graft and the native coronary vessel.
authors.affiliation: Section of Cardiology, Department of Internal Medicine and Percutaneous Coronary Intervention (PCI) Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: I-Chang
authors.initials: IC
authors.lastname: Hsieh
authors.affiliation: Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Pyng-Jing
authors.initials: PJ
authors.lastname: Lin
authors.affiliation: Section of Cardiology, Department of Internal Medicine and Percutaneous Coronary Intervention (PCI) Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Shang-Hung
authors.initials: SH
authors.lastname: Chang
authors.affiliation: Section of Cardiology, Department of Internal Medicine and Percutaneous Coronary Intervention (PCI) Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ming-Jer
authors.initials: MJ
authors.lastname: Hsieh
authors.affiliation: Section of Cardiology, Department of Internal Medicine and Percutaneous Coronary Intervention (PCI) Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Fen-Chiung
authors.initials: FC
authors.lastname: Lin
authors.affiliation: Section of Cardiology, Department of Internal Medicine and Percutaneous Coronary Intervention (PCI) Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Delon
authors.initials: D
authors.lastname: Wu
authors.affiliation: Section of Cardiology, Department of Internal Medicine and Percutaneous Coronary Intervention (PCI) Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Chen
mesh_terms: D001807:Blood Vessel Prosthesis; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome