Moderate stenosis in left main trunk side branches treated with single sirolimus-eluting stents should be observed witho
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ORIGINAL ARTICLE
Moderate stenosis in left main trunk side branches treated with single sirolimus-eluting stents should be observed without additional stenting Yasuko Kato • Nobuo Shiode • Kinya Shirota • Fumiyo Tsunoda • Mai Fujiwara • Asao Mimura
Received: 26 March 2010 / Accepted: 20 August 2010 / Published online: 26 November 2010 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2010
Abstract The sirolimus-eluting stent (SES) has dramatically reduced restenosis in patients with most types of coronary lesions, but bifurcation lesions remain a predictor of poor prognosis even in SES implantation. We aimed to determine the clinical outcomes of the left main trunk (LMT) side branches (SB) treated with a single SES strategy. SES implantation was successfully performed on 70 patients with LMT stenosis from August 2005 to August 2008. Of the 70 patients, 55 patients (59 SB) were treated with a single SES and a jailed SB. The 56 SB were divided into two groups according to percent diameter stenosis immediately following percutaneous coronary intervention (PCI) (Group 1: [50%; Group 2: \50%). Quantitative coronary angiography (QCA) data was evaluated. One year angiographic follow-up was performed on 23 patients (82.1%) in Group 1, and 21 patients (78.6%) in Group 2. Group 1 MLD was significantly larger at follow up than that post-PCI (0.9 ± 0.4 vs. 1.2 mm ± 0.6 mm, p \ 0.01). In Group 2, MLD and percent diameter stenosis did not change significantly. SB revascularization was not performed on either group at follow-up. Clinical outcomes of moderate stenosis in LMT SB treated with a single SES were acceptable, and stenosis progression within 1 year was minimal. We concluded that patients who present moderate residual stenosis in LMT SB with no presentation of ischemic symptoms should be observed rather than re-stented. The online version of the editorial referring to this article can be found under doi:10.1007/s12928-010-0040-1. Y. Kato (&) N. Shiode K. Shirota F. Tsunoda M. Fujiwara A. Mimura Department of Cardiology, Matsue Red Cross Hospital, 200 Horomachi, Matsue, Shimane 690-0866, Japan e-mail: [email protected]
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Keywords Restenosis
Sirolimus-eluting stent Left main trunk
Background The sirolimus-eluting stent (SES) has dramatically reduced restenosis rate in patients with most types of coronary lesions [1, 2]. SES implantation in the LMT is safe and efficacious compared with bare metal stents, and SES effectiveness in bifurcation lesions has been confirmed by prospective analysis [3, 4]. However, which stenting strategy is better for bifurcation lesions in the drug-eluting stent era remains uncertain. We aimed to determine the angiographical and clinical outcomes of LMT SB lesions treated with a single SES.
Methods Study subjects After SES was available in Japan in 2004, we started to treat LMT lesions with SES. If the patient with LMT stenosis had valvular disease or aortic disease that required operation, the patient was transferred to bypass surgery. From Augu
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