Left main diseases usually have extensive coronary artery disease cad, and the coexisting disease is often complex. Drugeluting stent for left main coronary artery disease. Become a gold or platinum member to access powerpoint files, presentation audio, and video. Prognosis and management of anterolateral myocardial infarction in patients with severe left main disease and cardiogenic shock. Superiority of surgery vs stents for longterm mortality in patients with left main disease unarguable. Left main protection and emergency stenting during tavr with. Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty. Very longterm followup for left main coronary artery stenting. Endoluminal stenting for unprotected left main stenosis in.
The idea was that left main stenting or left main disease is potentially a very dangerous disease, because if the artery closes, that means death, so you need. We have come a long way in planning interventions for left main with state of the art hardware, expertise and image assistance. About 5% of patients undergoing coronary angiography have significant disease of the left main coronary artery. Your browser does not currently recognize any of the video formats available. When it becomes narrowed it causes large areas of the heart to malfunction with subsequent severe anginal chest pain and breathlessness. Then, a stent is placed at the ostium of the side branch lcx with a balloon left in the main stent. That said, significant left main coronary artery lm disease in the context of tavr represents an additional challenge for 2 reasons. Longterm safety and efficacy of stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease. Superiority of surgery vs stents in left main unarguable.
An echocardiographic clue for ostial left main coronary artery stenosis. Crush wire both vessels predilate both two stents are then advanced and positioned into each vessel of the bifurcation with the proximal end of the sidebranch stent in the main vessel the sidebranch stent is deployed first the main branch stent. Longterm outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease. Live case 1 left main bifurcation lesion pci using 2 stent strategy and ivus device ccvvc 2017. Because of the large myocardial volume supplied by the left circumflex artery lcx in many patients, the possibility of circulatory collapse after main vessel mv stenting should always be considered. Coronary stents are now used in more than 90% of pci procedures. Use of rotablation and dk crush technique in left main bifurcation and heavily calcified two vessel disease. How is an angioplasty and stent procedure performed.
Everolimuseluting stents or bypass surgery for left main coronary. Everolimuseluting stents or bypass surgery for left main. It is used in a procedure called percutaneous coronary intervention pci. To understand the best treatment options for patients presenting with left main and complex bifurcations lesions. Tap technique for a left main bifurcation lesion with a large aneurysm at proximal lad cardiovascular division, departments of internal national taiwan universit y hospital, taipei, taiwan.
Pci to distal left main trifurcation disease with final trising balloons. In the main compare registry, patients with unprotected left main coronary artery stenosis in a hemodynamically stable condition underwent elective stenting under the guidance of ivus 756. Coronary artery bypass surgery is considered as the gold standard treatment of unprotected left main coronary artery ulmca disease. Left main stenting about detection of obstructive disease of the left main coronary artery lmca is relatively unusual in the catheterisation laboratory, as it accounts for approximately 4% of all coronary angiograms, with isolated lmca disease observed in only 510% of these cases. Stenting or bypass surgery for unprotected left main. Coronary obstruction after valveinvalve transcatheter. Oct 20, 2016 ctscans show left main stem stenting after coronary obstruction in valveinvalve tavi, implanting a bostonscientificlotus prosthesis 27 mm, a image provided courtesy of boston scientific in an insufficient stentless sorinsolo bioprosthesis 25mm, b image provided courtesy of livanova. A coronary stent is a tubeshaped device placed in the coronary arteries that supply blood to the heart, to keep the arteries open in the treatment of coronary heart disease. The findings support current clinical guidelines stating that left main stenting is a feasible revascularization strategy for patients with suitable coronary anatomy, according to the researchers. To learn how to optimise both strategy and technique. Patients with advanced aortic calcification, low life expectancy, chronic obstructive pulmonary disease, or cerebrovascular disease, for instance, may. The left main coronary artery stenosis requires prompt emergency evaluation and. Left main stenting was performed according to the previously reported le mans protocol.
Simultaneous transfemoral tavi and angioplasty of unprotected. Bifurcation angioplasty is a newly conqueredor not yet. A randomized, international, multicenter clinical trial. Percutaneous intervention of unprotected left main disease. An 86 symptomatic year old male with left main trunk stenosis and osteal lad stenosis evaluated by ivus for stenosis assessment, step procedures, and expansion of stenting.
In coronary angiography a lesion in the left main coronary artery lmca is found. The left main stem subtends a large amount of myocardium and may be associated with ventricular dysfunction, arrhythmia, or hemodynamic compromise, making it a potentially lethal condition. The evolution of such tools as balloon angioplasty, baremetal stents bms and now drugeluting stents des has incrementally opened up new possibilities in the treatment of coronary artery disease and, correspondingly, an everdecreasing need for invasive surgery. Very longterm followup for left main coronary artery. Temporary pacemaker and intraaortic balloon pump can also be seen. Posted in cardiology animations, cardiology emerging technology, cardiology interventional pci, cath lab tips and tricks, left main stenting tips and tricks, uncategorized, tagged aorto ostial left amin stenting, aorto ostial lesions, buttoned stent for left main ostium, how to do left main stenting, left main ostial stenting, left main. Ulmca disease treated medically have a 3year mortality rate of 50%.
Sep 03, 2007 clinical seminar, left main stem angioplasty, 168001. Determining when left main stenting is the best option left main coronary artery stenting is typically suitable for patients who are at high risk for surgical complications or have comorbidities. Muller, mbbs we describe 2 patients with takayasus arteritis and left main coronary stenosis who were. Direct stenting of the left main was a preferred strategy except for cases with critical luminal narrowing, for which predilation was performed with small balloons 2. Significant left main coronary artery lmca stenosis, which is defined as a 50% diameter stenosis that corresponds to a 75% area stenosis of the lmca. Ladd2 bifurcation lesion pci using 2 stent technique ccc live oct 2016. This interview was recorded on november 18, 2019, at the american. Tap technique for a left main bifurcation lesion with a large. The coronary angiography reveals a severe left main trunk stenosis on its distal part and an intermediate stenosis of the proximal part of the left. Isar left main intracoronary stenting and angiographic results.
Further randomized study is warranted to confirm the benefits of dk crush stenting for complex uplmb lesions. Selecting a left main bifurcation treatment strategy. The optimal method of revascularization for patients with left main coronary artery disease lmcad is controversial. Quigley rl, milano ca, smith lr, white wd, rankin js, glower dd. After positioning the proximal edge of the side branch stent 12 mm inside the main stent, the side branch stent is delivered at high pressure while a deflated balloon is left in the main stent. Endoluminal stenting for unprotected left main stenosis in takayasus arteritis kirti punamiya, md, eric r. The facts and conclusions presented may have since changed and may no longer be accurate. Left main and complex bifurcation stenting a transradial approach.
Over the last 20 years, improvement in stent technology and operators experience explained the increased number of reports on the results of percutaneous coronary interventions pcis for the treatment of left main lm coronary artery lesion. Randomized trial of stents versus bypass surgery for left. Left main bifurcation stenting a casebased approach. Recently, several reports on protected or unprotected lmca stenting, or both, suggested the. Complex left main culotte bifurcation pci by using modified highway technique through radial approach. Ivus guidance was used in order to optimize the final result. However, every classification, approach, strategy for bfl talks about tackling the main. In the past few decades, tremendous developments have been made in the field of interventional cardiology. Stenting of a left main coronary artery dissection and stent. Left main bifurcation stenting techniques pcronline. Complex double stent techniques in left main disease pcr. The left main coronary artery supplies at least two thirds of the hearts blood supply. Aug 19, 2009 stenting a good option for left main heart artery.
Comparison of percutaneous coronary angioplasty versus surgical. A 71yearold man presented with acute type a aortic dissection. Stenting of unprotected left main coronary artery stenoses. I can only see the case description but no video link to the case. Subsequent rotablation and stenting of the left main and lad with. Original article from the new england journal of medicine everolimuseluting stents or bypass surgery for left main coronary artery disease. Left main and complex bifurcations stenting pcr virtual. Left main stenting dr mahendra cardiology,jipmer 2. Emergency stenting of the left main coronary artery after. Data to clinical practice debabrata dash and shaoliang chen fortis raheja hospital, raheja rugnalaya marg mahim west, 400016 mumbai, india. As effective as standard of bypass surgery, polish study finds. Ostial lad cto pci via retrograde approach march 2020 ccc. Backgroundpatients with obstructive left main coronary artery disease are usually treated with coronaryartery bypass grafting cabg. Double kissing and double crush versus provisional t stenting technique for the treatment of unprotected distal left main.
We examined the immediate and longterm outcomes after stenting of unprotected left main coronary artery lmca stenoses in patients with normal left ventricular lv function. Drugeluting stents for unprotected coronary left main lesions study investigators 2009 paclitaxel versus sirolimuseluting stents for unprotected left main. Pdf stenting of left main coronary artery stenosis. Double kissing and double crush versus provisional t stenting technique for the treatment of unprotected distal left main true bifurcation lesions. Take a peek at how this procedure opens narrow arteries to help blood flow more freely. Live case 1 left main bifurcation lesion pci using 2. Ivus evaluation of left main coronary artery disease and stenting pr christophe dubois and johan bennett. One day after admission, dissection of the left main coronary artery accompanied by severe myocardial ischemia prompted palmaz stent placement. Practical based approach to left main bifurcation stenting. Focal ostial stenting may result in incomplete lesion coverage or plaque shift into the adjacent vessel, creating left main equivalent disease. Finally, a fourth drugeluting stent was implanted a 4 x 8 mm zotarolimuseluting stent in the left main coronary artery figure 3 and video 2 of the supplementary. Current management of left main coronary artery disease. Coronary artery bypass graft surgery cabg has traditionally been considered the gold standard therapy, and recent randomized trials comparing cabg with percutaneous coronary intervention pci with drugeluting stents des have reported conflicting outcomes. May 02, 2016 dr honisz, pracownia hemodynamic slaskiego centrum chorob w zabrzu, poland shares a case of a distal left main stenosis treated with an xposition s sirolimuseluting balloondeliverable self.
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