Left main coronary artery rotational atherectomy and stenting

Background. Coronary artery bypass surgery is a difficult option in patient s who are not candidates for bypass surgery and high-risk patients with cri tical left main coronary artery (LMCA) disease. We report outcomes and shor t-term follow-up of patients who had LMCA rotational atherectomy and/or ste nting, assess the role of these interventions in protected and unprotected significant LMCA stenosis, and review the literature. Methods, We reviewed the cases of seven men with critical LMCA stenosis for whom coronary artery bypass surgery was considered a high risk. Five patie nts had rotational atherectomy, one had coronary artery stenting, and one h ad both. Results. In all cases, angiographic success was achieved, and symptoms were relieved. Six patients were discharged from the hospital in 3 to 6 days. O ne patient who had cardiogenic shock, respiratory failure, and acute renal failure before the procedure died of arrhythmia 4 days afterward. Another p atient had elective coronary artery bypass graft surgery 3 weeks later for recurrent angina. Cardiac catheterization was repeated in 1 month for chest pain in three patients at 4 to 7 months follow-up, and none had progressio n of residual stenosis in the LMCA. Conclusions. Our study suggests that LMCA rotational atherectomy and stenti ng are safe and effective revascularization procedures in high-risk patient s and patients who are not candidates for bypass surgery.