Experience of LMCA Angioplasty from a Referral Center and in Hospital Outcomes
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Introduction and Objectives: CABG is the treatment of choice for severe left main coronary artery stenosis. The results of a number of multicenter trials have suggested angioplasty with stenting as a possible alternative treatment. Previous studies demonstrated procedural success of 90-100% and Mortality 0.8-2% So, want to see these parameters in Asian population though the LMCA registry of a referral center institute.
Material and Methods: We have collected data from patient records who underwent LMCA angioplasty procedure (both unprotected or protected LMCA) performed at our institution between April 2003 to July 2015. Detailed in-hospital data including age, gender, coronary risk factors, procedural events were obtained and analyzed.
Results: Angiographically documented success was obtained in 98% patients with zero mortality. In 134 patients the lesions were pre-dilated using a conventional balloon. In 19 patients direct stenting was done. The median diameter and length of the stent was 3.2542 mm and 13.790 mm, respectively. POBA was done in two cases, BMS were used in 27 cases, DES were used in 124 cases.
Only LMCA stenting was done in 53 cases LMCA with other vessels stenting was done in 98 cases. FFR was used in 2 cases, Kissing balloon dilatation was used in 8 cases, ostial flaring was done in 5 cases. There was no mortality in the study but on table stent thrombosis was seen in one patient for which thrombuster was used, IABP was placed immediately and sent for CABG. For one case result was suboptimal.
Conclusions: Present study demonstrated that stenting for significant LMCA disease is safe and feasible with very high procedural and clinical success rates and zero mortality. LMCA-left main coronary artery, POBA-plain old balloon angioplasty, PCI-Percutaneous coronary intervention, CABG-coronary artery bypass grafting, FFR-Fractional flow reserve, TIMI- thrombolysis in myocardial infarction, DES-drug eluting stent, BMS-bare metal stent, TLR-Target lesion revascularization.