Elective stenting of unprotected left main coronary artery stenosis - Effect of debulking before stenting and intravascular ultrasound guidance

OBJECTIVES We sought to evaluate: 1) the long-term outcomes of 127 selected patients receiving unprotected left main coronary artery (LMCA) stenting; and 2) the impact of the debulking procedure before stenting and intravascu lar ultrasound (IVUS) guidance on their clinical outcomes. BACKGROUND The long-term safety of stenting of unprotected LMCA stenoses ha s not been established yet. METHODS A total of 127 consecutive patients with unprotected LMCA stenosis and normal left ventricular function were treated by elective stenting. The long-term outcomes were evaluated between two groups: IVUS guidance (n = 7 7) vs. angiographic guidance (n = 50); and debulking plus stenting (debulki ng/stenting; n = 40) vs. stenting only (n = 87). RESULTS Angiographic restenosis was documented in 19 (19%) of 100 patients. The lumen diameter after stenting was significantly larger in IVUS-guided group (p = 0.003). The angiographic restenosis rate was significantly lower in the debulking/stenting group (8.3% vs. 25%, p = 0.034). The reference a rtery size was the only independent predictor of angiographic restenosis. D uring follow-up (25.5 +/- 16.7 months), there were four deaths, but no nonf atal myocardial infarctions occurred. The survival rate was 97.0 +/- 1.7% a t two years. CONCLUSIONS These data suggest that stenting of unprotected LMCA stenosis m ight be associated with a favorable long-term outcome in selected patients. Guidance with IVUS may optimize the immediate results, and debulking befor e stenting seems to be effective in reducing I the restenosis rate. However , we need a large-scale, randomized study. (C) 2001 by the American College of Cardiology.