This interview was recorded on november 18, 2019, at the american. Left main stenting was performed according to the previously reported le mans protocol. Original article from the new england journal of medicine everolimuseluting stents or bypass surgery for left main coronary artery disease. Drugeluting stents for unprotected coronary left main lesions study investigators 2009 paclitaxel versus sirolimuseluting stents for unprotected left main. 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. Double kissing and double crush versus provisional t stenting technique for the treatment of unprotected distal left main true bifurcation lesions. Complex left main culotte bifurcation pci by using modified highway technique through radial approach. Original article from the new england journal of medicine randomized trial of stents versus bypass surgery for left main coronary artery disease. Focal ostial stenting may result in incomplete lesion coverage or plaque shift into the adjacent vessel, creating left main equivalent disease. 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.
The left main coronary artery supplies at least two thirds of the hearts blood supply. Backgroundpatients with obstructive left main coronary artery disease are usually treated with coronaryartery bypass grafting cabg. Left main protection and emergency stenting during tavr with. A 71yearold man presented with acute type a aortic dissection. The facts and conclusions presented may have since changed and may no longer be accurate. As effective as standard of bypass surgery, polish study finds. 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. 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. Left main stem angioplasty european society of cardiology.
Ulmca disease treated medically have a 3year mortality rate of 50%. The optimal method of revascularization for patients with left main coronary artery disease lmcad is controversial. Live case 1 left main bifurcation lesion pci using 2. Randomized trial of stents versus bypass surgery for left.
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. Very longterm followup for left main coronary artery. It is used in a procedure called percutaneous coronary intervention pci. Stenting of unprotected left main coronary artery stenoses. Coronary artery bypass surgery is considered as the gold standard treatment of unprotected left main coronary artery ulmca 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. Complex double stent techniques in left main disease pcr. Your browser does not currently recognize any of the video formats available. Drugeluting stent for left main coronary artery disease. To learn how to optimise both strategy and technique.
Isar left main intracoronary stenting and angiographic results. Percutaneous intervention of unprotected left main disease. About 5% of patients undergoing coronary angiography have significant disease of the left main coronary artery. Left main bifurcation stenting techniques pcronline. 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. When it becomes narrowed it causes large areas of the heart to malfunction with subsequent severe anginal chest pain and breathlessness. 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. Ivus guidance was used in order to optimize the final result. We have come a long way in planning interventions for left main with state of the art hardware, expertise and image assistance. Emergency stenting of the left main coronary artery after. Then, a stent is placed at the ostium of the side branch lcx with a balloon left in the main stent. Use of rotablation and dk crush technique in left main bifurcation and heavily calcified two vessel disease.
Practical based approach to left main bifurcation stenting. Current management of left main coronary artery disease. A randomized, international, multicenter clinical trial. Unprotected left main stenosis and bifurcation lesions. Muller, mbbs we describe 2 patients with takayasus arteritis and left main coronary stenosis who were. In the past few decades, tremendous developments have been made in the field of interventional cardiology. Patients with advanced aortic calcification, low life expectancy, chronic obstructive pulmonary disease, or cerebrovascular disease, for instance, may. 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. 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. Left main and complex bifurcations stenting pcr virtual. Stenting or bypass surgery for unprotected left main. The left main coronary artery stenosis requires prompt emergency evaluation and. Longterm outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease. Bifurcation angioplasty is a newly conqueredor not yet.
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. Endoluminal stenting for unprotected left main stenosis in takayasus arteritis kirti punamiya, md, eric r. Left main bifurcation stenting a casebased approach. Ivus evaluation of left main coronary artery disease and stenting pr christophe dubois and johan bennett. Pdf stenting of left main coronary artery stenosis. One day after admission, dissection of the left main coronary artery accompanied by severe myocardial ischemia prompted palmaz stent placement. Live case 1 left main bifurcation lesion pci using 2 stent strategy and ivus device ccvvc 2017. Take a peek at how this procedure opens narrow arteries to help blood flow more freely. Everolimuseluting stents or bypass surgery for left main.
However, every classification, approach, strategy for bfl talks about tackling the main. Temporary pacemaker and intraaortic balloon pump can also be seen. Data to clinical practice debabrata dash and shaoliang chen fortis raheja hospital, raheja rugnalaya marg mahim west, 400016 mumbai, india. Ostial lad cto pci via retrograde approach march 2020 ccc. Isolated disease of the ostium left anterior descending or. How is an angioplasty and stent procedure performed. I can only see the case description but no video link to the case. Superiority of surgery vs stents for longterm mortality in patients with left main disease unarguable. 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. Recently, several reports on protected or unprotected lmca stenting, or both, suggested the.
Endoluminal stenting for unprotected left main stenosis in. 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. Become a gold or platinum member to access powerpoint files, presentation audio, and video. 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. 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. Pci to distal left main trifurcation disease with final trising balloons. Coronary stents are now used in more than 90% of pci procedures. Left main and complex bifurcation stenting a transradial approach. 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.
That said, significant left main coronary artery lm disease in the context of tavr represents an additional challenge for 2 reasons. Tap technique for a left main bifurcation lesion with a large. Stenting of a left main coronary artery dissection and stent. Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty. Superiority of surgery vs stents in left main unarguable.
To understand the best treatment options for patients presenting with left main and complex bifurcations lesions. Very longterm followup for left main coronary artery stenting. Quigley rl, milano ca, smith lr, white wd, rankin js, glower dd. Prognosis and management of anterolateral myocardial infarction in patients with severe left main disease and cardiogenic shock. 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. Everolimuseluting stents or bypass surgery for left main coronary. 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. In coronary angiography a lesion in the left main coronary artery lmca is found. 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. Coronary obstruction after valveinvalve transcatheter. 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. Stenting or bypass surgery for unprotected left main coronary.
The physicians on the medical staff at baylor hamilton heart and vascular hospital have successfully treated patients with left main disease using percutaneous coronary intervention pci techniques with stents, providing a rapid, lessinvasive procedure, and a faster hospital discharge and return to daily activities. An echocardiographic clue for ostial left main coronary artery stenosis. Aug 19, 2009 stenting a good option for left main heart artery. 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.
Subsequent rotablation and stenting of the left main and lad with. Sep 03, 2007 clinical seminar, left main stem angioplasty, 168001. Ladd2 bifurcation lesion pci using 2 stent technique ccc live oct 2016. Left main stenting dr mahendra cardiology,jipmer 2. Longterm safety and efficacy of stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease. 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. Further randomized study is warranted to confirm the benefits of dk crush stenting for complex uplmb lesions. 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. Selecting a left main bifurcation treatment strategy. Left main diseases usually have extensive coronary artery disease cad, and the coexisting disease is often complex.
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