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563

LEFT MAIN TRUNK INTERVENTION WITH DRUG ELUTING STENTS – A CASE SERIES

AC Taylor, S Radhakrishnan, J Cohen, A Dick, J Pang, M Madan, S Naqvi, D Ko, E Cohen

Toronto, Ontario

BACKGROUND: Left main intervention with uncoated stents has been used to treat atherosclerotic lesions in subjects who are not appropriate for primary CABG or surgical revision after previous CABG. Restenosis in this location with uncoated stents can be life threatening and drug eluting stents may offer a mechanism to significantly reduce this risk.

METHODS: The purpose of this study was to demonstrate the feasibility and safety of percutaneous left main intervention with drug eluting stents in this high risk group and assess the clinical and angiographic outcomes post intervention and at 6 months. Surveillance angiography was planned at 3-6 months. All patients had CCS Class III or IV angina and obstructive left main trunk lesions. These patients were not suitable candidates for surgery.

RESULTS: Eleven patients underwent percutaneous intervention to the left main trunk with drug eluting stents at our institution between July 2003 and February 2004. 45% of the patients had an unprotected left sided circulation. The mean patient age was 67 years. There were no deaths in the peri-procedural period. There were no episodes of stent thrombosis and there was one myocardial infarction (CKMB 3 ´ UL Normal). All patients had reduction of their angina to CCS Class I-0 following the procedure. QCA Results at the time of procedure: Mean Minimal Lumen Diameter Pre Procedure 1.35 mm (0.87-2.66 mm) Post Procedure 2.99 mm (1.62-3.96 mm). The average acute gain was 1.634 mm. The mean pre procedure diameter stenosis was 53% (32-66%) with a mean post procedure diameter stenosis of 12% (0-40%). The average lesion length was 5.4 mm with an average vessel size of 3.14 mm. Nine of the eleven patients received paclitaxel eluting stents while the other two patients received sirolimus eluting stents. To date one patient has had symptomatic restenosis with a 75% diameter restenosis demonstrated on angiography.

CONCLUSION: 1. Left main trunk intervention with drug eluting stents is safe and feasible in the setting of left main trunk disease with and without previous CABG. 2. Procedural outcomes are satisfactory with a high rate of success and low rate of morbidity. Complete 6 month clinical and QCA data will be presented in October 2004.

DNC

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