Optimization by intravascular ultrasound of left main coronary artery angioplasty

Introduction: Surgical myocardial revascularization is the conventional treatment for patients (pts) with an unprotected left main coronary artery disease (ULMCAD). Percutaneous Transluminal Coronary Angioplasty (PTCA) with drug-eluting stents (DES) is a feasible option, with low rates of revascularization due to restenosis of the treated lesion, and with mortality similar to surgery. Objective: To evaluate the effectiveness of PTCA with DES optimized by intravascular ultrasound (IVUS) in patients with ULMCAD. Combined events of death, myocardial infarction (AMI), stroke, or revascularization of a treated lesion (RTL) were considered. Methods: Prospective registry of consecutive pts with ULMCAD treated with IVUS-guided DES PTCA. Results: Twenty-four pts, mean age 65.7 +/- 12.1 years; 83% male, 21% diabetes. Multi-vessel disease 88%; calcified lesion 13.6%; 1.5 +/- 0.85 stents / patient were implanted. Syntax Score <22 in 66.6%, 23-32 in 29.1%; bifurcation stenosis 87%; implanted with the provisional stent technique 77.3%. Mean luminal area of DES 9.3 mm(2). Balloon re-intervention due to hypoexpansion and/or lack of wall apposition 33.3%. In-hospital evolution: 1 pt sub-clinical infarction (4.1%). Average follow-up 283 +/- 63 days: 1 pt AMI secondary to late stent thrombosis (2.7%). In-hospital and late AMI and stroke 0%. Conclusions: PTCA with DES optimized with IVUS guide in ULMCAD in our experience is a safe procedure, with a low incidence of major in-hospital and late complications; therefore, it could be considered as an alternative to surgical myocardial revascularization.