Blengino, Simonetta

Colombo, Antonio

Di Francesco, Lucia

Di Mario, Carlo

Ferraro, Massimo

Finci, Leo

Hall, Patrick

Itoh, Akira

Maiello, Luigi

Martini, Giovanni

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Stenting in protected and unprotected left main coronary artery: Immediate and follow-up results 

.IACC February 1996 
ABSTRACTS- ORAL 
277A 
Expand ing  Ind icat ions  fo r  Stent  P lacement  
Wednesday,  March 27, 1996, 8:30 a.m.-10:00 a.m. 
Orange County Convent ion  Cents¢, Room 314 
8:3O 
~' -~ Imnt~diate and Late Outcome After Carotid 
Angioplasty (PTA) end Stenting 
Sanlay S. Yadav, Gary S. Roabin, Sdram S. lyer, Peter King, J. 
Michael Parks, Suresh R Jain, Chdstopher Goods, Jid Vitek, Roneld 
L. Levine. University of Alabama at Birmingham, Birmingham, AL 
From 9/8/94 to 8/30/95, 85 pts, (55 symptomatic) had 96 carotid artedes 
treated in an IRB approved single-center, prospective study evaluating the 
immediate and long term efficacy of percuteneous carotid PTA end stenting. 
Symptomatic end asymptomatic pts. with > 60% carotid stenosis were 
eligible. The protocol required independent neurological evaluation pre- and 
post-procedure, at 6 weeks and 6 months and carotid angiography at 6 
months, 
Results: Angiographlc success was 99%; 100=/o had successful stem de- 
ployment and stem thrombosis was 0%. Doe hundred forty-six stents (120 
Johnson & Johnson, Inc., 26 Cook, Inc.) wore deployed for a mean stem to 
artery ratio of 1.5 (range 1 to 6). Mean stenosls was reduced from 74% .4-14% 
to 3% :E 16%. There were no major procedural strokes, MIs or deaths. There 
were 5 (5%) minor (complete recovery within 7 days) procedural strokes and 
1 (1%) major in-hospital stroke secondary to atrial fibrillation. There was 1 
death secondary to ratro-peritoneal b eeding. Twenty-two pts. have reached 
the 6 month engiography endpoim with a mean stenosis of 12% -4- 16=/o 
(range - 7 to 57°/=) and I case of restenosis. Deformation of the stem ends 
was noted in 5 pts, and in 1 pt. repeat balloon dilatation was performed. Late 
neurologic events have not occurred. Two pts. have died in follow-up from 
non-cerebrovascular causes. 
Conclusion: Carotid angioplasty and stentiog is associated with a high 
immediate success rate and a modest complication rate. Angiographic follow- 
up to date shows a low incidence of rest:nosis. 
8:45 
Stenting of  Unprotected Left Main Coronary Artery 
Stenosis Without Coumadln 
Jean Fajadet, Philippe Brunet, Chd~,:ian Jordan, Bernard Cassagneau, 
Jean Marco. Clinique Pastet~; Toulouse, France 
Left main coronen/artew (LMCA) disease is considered as an absolute 
indication for bypass surgery. However, particular situations unfevourable 
to CABG can lead to PTCA attempt. The aim of this study is to determine 
whether stent (S) implantation with the new S management (high pressures 
for S delivery, ant[platelat regimen with Aspidn and Tidopldine, and without 
Coumadin) can be used for the treatment of LMGA stenoses. 
Unprotected LMCA S implantation was performed In 26 consecutive pa- 
tients (pts) treated with Aapidn (100 Pg/day) and Tlclupldine (250 rag/day): 
23 males, mean age of 68.2 ± 10.6 years, 20 pts had unstable angina, LVEF 
was 54.3 4- 11%, 8 pts had two vessel disease, 18 pts had three vessel 
disease. Stsnting was elective in 17 pts and non elective in 9 pts. LMCA 
stenting was achieved suCCessfully in all pts with balloon inflation pressure 
> 16 Arm. Thirteen pts received Palmaz-Schatz S, 11 pts Gienturee Roubin 
S and 2 pts AVE S. No acute or subacute thrombosis occurred. No major 
cardiac events (repeat PTCA, CABG, myocardial infarction, death) occurred 
dudng hospital stay. Clinical follow-up obtained in all pts, 7 rponths (1-24 
months) after the procedure, showed: repeat PTCA for restenosis In 5 pts, no 
CABG or myocardial infarction, sudden death in one 10t, 2 pts had frm~onel 
class 2 angina and 23 tots had no symptoms. 
Conclusion: Unprotected LMCA atenting, using high pressures for $ deliv- 
ery and combination of Aspidn and Ticlopidine can be considered as feasible, 
safe and effective coronary revasculadzation procedure in selected pts who 
are poor candidates for CABG. 
9:00 
Stenting in Protected and Unprotected Left Main 
coronary  Artery: Immediate and Fol low-Up Results 
Akira Itoh, Antonio Colombo, Patrick Hall, Luigi Malello, Carlo Di Mario, 
Simonetta Blengino, Masalmo Ferraro, Giovanni Martini, Lucia Di 
Frencesco, Leo Finci. Columbus HospitN, Milan, Italy 
PTCA of the left main coronmy artery (LM) has been associated with a 
poor clinical follow-up results. We analyzed our results of coronery stem 
implantation i  the LM from the entire stent group of 1679 lots. A total of 33 
patients were treated with 38 Palmaz-Schatz stents and 5 AVE stents. In 15 
patients an unprotected LM lesion were treated and 18 pts had a functioning 
bypass conduit on another vessel (protected LM). The indications for ster~ng 
were elective for 27 lots, dissection for 3 pts, and suboptimal result after 
balloon engioplasty for 3 pts. Angiogrephic success was achieved in 31 pts 
(94%). An emergency CABG during stem implantation was done in I pt, and 
1 pt had an unsuccessful stent deployment. Table shows the engiographic 
results: 
Baseline Post-Steflt Follow-Up 
MLD (mm) 1.37 ± 0.76 3.58 d: 0.60 2.48 4. 0.B9 
Diameter Stenosis (%) 634.18 4±6 324.22 
Aogiographic follow-up was performed in 15 patients (48% of eligiole 
patients). Restenosis by 50% diameter stenosis oriteda occurred in 2 lesions 
(13%). Clinical follow-up was available in all patients at a mean intewal of 
20 ± 12 months. There were 3 deaths within 3 months of the procedure: 2
of them due to LM closure preceded by unstable angina and 1 of uncertain 
cause. Two other patients died during the 2 yearn fellow-up because of 
malignancy. 
Conclusion: W'dh the technology presently available stanting of LM lesions 
carries a high short term risk and should be restricted to selected patients 
who am not considered optimal surgical candidates. 
9:15 
~ ' ~  Coronary Stenting of Bifurcation Lesions:  
Immediate and Follow-Up Results 
Antonio Colombo, Lulgi Malello, Akira Itoh, Patrick Hall. Carlo Di Mado, 
Slmonefta Blengino, Massimo Ferram, Giovanni Martini, Lucia Di 
Francesco, Lee RnoL Columbus Hospital, Milan, Italy 
The transcatheter treatment of lesions at coronary bifurcation is a subject 
of controversy. This study evaluated immedmte nd long-term efficacy of 
stent implentation in such lesions. We treated 38 major bifurcation lesions 
in 34 patients (mean age 61 ± 10 years). The lesion disth'bution was: 16 
LAD-Diag, 11 RCA (PD-PL), 7 LCX-OM, 4 LAD-LCX. Stem indications were: 
31 elective (79%), 1 restenosis (3%), 2 suboptimal PTCf.. and 4 dissection 
after PTCA. Patients were divided into two groups according to the 5tenttng 
sVatogy. Group I (h = 18): stestiog on beth vessels involved in the bifurcation 
lesion; Group II (n = 20): stenting on one vessel and balloon (Idsaiog) dilation 
of the other vessel. Table shows procedural and follow-up data: 
Group I Group II 
Successful stsnting 16 (89%) 19 (95%) 
Stent per patient 2.5 4. 2.0 1.5 4-1.1 
Procedural compllcstlons 2 (11%) 1 (5%) 
Stent hrombosis 1 (6%) I (5%) 
Death at I month 1 (6%) 0 
Conclusion: Stsming of bifurcation lesions was confronted with technical 
complexity and a relatively high event rate after the procedure in this small 
cohort. Improvements in stem design may be necessary to overcome some 
of these limitations. 
9:30 
~ " ~  Multivessel Palmaz-Schatz Stspting: Acute Results 
and Long-Term Outcome 
Roger J. Laham, Aaron D, Bermen, Richard E. I~untz, Donald S. Balm, 
David J. Cohen, Joseph R Carrozza, Harvard Medical School, Beth Israel 
Hospital, Boston, MA 
Palmaz-Schalz stenting (PSS) has been approved for the treatment of de- 


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Stenting in protected and unprotected left main coronary artery: Immediate and follow-up results

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