PERCUTANEOUS TREATMENT OF PROTECTED AND UNPROTECTED LEFT MAIN CORONARY STENOSES WITH NEW DEVICES - IMMEDIATE ANGIOGRAPHIC RESULTS AND INTERMEDIATE-TERM FOLLOW-UP

Objectives. We sought to evaluate the immediate angiographic results a nd intermediate term follow-up after percutaneous treatment of left ma in coronary stenoses in the new device era. Background. Historically, balloon angioplasty of left main coronary stenoses has been associated with high procedural morbidity and poor long-term results. It is not clear whether new devices are more effective in this anatomic setting. Methods. Between July 1993 and July 1995, we performed initial left m ain coronary interventions on 46 patients (mean age 67 +/- 12 years, 2 6% women). Quantitative angiography,vas available for 42 of 46 interve ntions, and clinical follow up was obtained for all patients at 1 mont h, 6 months and 1 year after initial revascularization. Results. Most interventions (42 of 46) mere performed in patients with ''protected'' coronary stenoses to the left coronary system owing to the presence o f one or more patent left main coronary grafts, Seventy seven percent of screened patients were deemed unsuitable for repeat coronary artery bypass surgery. Procedures performed included stenting in 73% of pati ents (alone in 30% and after rotational atherectomy in 43%), rotationa l atherectomy in 58% (alone in 15% and before stenting in 43%), direct ional atherectomy in 4% and angioplasty alone in 7%. Initial procedura l success was achieved in all interventions, with no deaths, myocardia l infarctions (creatine kinase, MB fraction >50 IU/liter) or emergent bypass surgery, Follow up data to date (median duration 9 months, rang e 6 to 19) demonstrate a 98% overall survival rate and a 6-month event -free survival rate of 78% (six target vessel revascularizations [TVRs ], four non-TVRs). Conclusions. Treatment of protected left main coron ary artery stenoses can be accomplished safely and effectively with ne w device technology. Intermediate-term follow-up demonstrates an accep tably low rate of death, myocardial infarction or repeat revasculariza tion at 6 months and 1 year. (C) 1997 by the American College of Cardi ology.