מתוך medicontext.co.il
By Will Boggs, MD
WESTPORT, CT (Reuters Health) – Stenting may be effective for many patients with left main coronary artery [LMCA] stenosis and normal ventricular function, according to a report in the October Journal of the American College of Cardiology.
Early trials of angioplasty for LMCA stenosis were discouraging, the authors explain, but the advent of intravascular ultrasound [IVUS] imaging, debulking techniques, and effective antiplatelet agents has reopened the case for LMCA angioplasty and stenting.
Dr. Seung-Jung Park from University of Ulsan in Seoul, Korea, and colleagues evaluated long-term results in 127 patients with normal left ventricular function who underwent LMCA stenting, and assessed the impact of IVUS and debulking in a subset of the patients.
The 77 patients in the IVUS-guided stenting group had significantly larger lumen diameters than did angiography-guided patients before and after the procedure, the authors report, though these differences disappeared by the time of followup.
Restenosis rates (19% overall) did not differ significantly between the IVUS- and angiography-guided stenting groups, the report indicates. However, the 40 patients that underwent debulking before stenting had a significantly lower rate of angiographic restenosis (8.3%) than did the 87 patients who underwent stenting only (25.0%) (p = 0.034).
Four patients died in the 2 years following the procedure, the researchers report, representing a 2-year survival rate of 97% and a 2-year major cardiac event-free survival rate of 86.9%.
"[In a selected group of patients who] have normal ventricular function, percutaneous intervention [stenting] of left main disease may be an effective alternative to surgery," Dr. Park told Reuters Health. "It takes just 30 minutes with high procedural success rate, no procedure-related mortality, no subacute mortality, and good long-term outcome."
"Although the IVUS evaluation for those lesions could not give any benefit for the late outcome," Dr. Park added, "we should consider IVUS first before stenting to assess unusual lesion morphology. And also, [an] IVUS-guided procedure is necessary for the effective debulking."
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