UNPROTECTED LEFT MAIN STEM STENTINGAN EXPERIENCE FROM OUR CENTRE

Abstract

Background: Coronary artery bypass grafting (CABG) has long been regarded as the treatment of choice for unprotected left main coronary artery (LMCA) disease. Left main stem stenting remains a dilemma despite the latest developments in percutaneous coronary stenting. Percutaneous coronary intervention can be a safe and effective method for revascularization in this subset of patients however it has typically been reserved for poor surgical candidates. Recently some randomized data has emerged comparing unprotected left main stem stenting to CABG. We wanted to share our experience regarding left main stem stenting as Army Cardiac Centre is a high-volume Centre, has skilled operators and cardiac surgical backup.

Objective: To share experience of Left main stem stenting from Army Cardiac Centre Lahore and determining that left main stem stenting is a suitable alternative to coronary artery bypass grafting in selected patients.

Study Design: A observational study.

Place and Duration of Study: Army Cardiac Centre Lahore during the period 1st January 2013 to 26 May 2018.

Material and Methods: Fifty Six patients who underwent left main stenting at Army Cardiac Centre Lahore during the period 1st January 2013 to 26 May 2018 were included in the study. A list of variables was devised to be included in the study. All patients underwent provisional left main stem stenting.

Results: Out of 56 patients 14 had ostial and midshaft disease while rest had distal left main stem disease. A provisional stenting approach was taken in all of the patients. Single stent was used in 50 patients while 6 patients went under bifurcation stenting. All patients had TIMI III flow in both Left Anterior Descending (LAD) and Left Circumflex (LCx) arteries after stenting.

Conclusion: Left main stenting is a safe procedure in selected patients however technique, operator skill and cardiac surgical backup play a vital role in the success of this procedure.