We sought to evaluate procedural technical feasibility; MACE including cardiac mortality at hospital discharge and thirty day follow up after stenting unprotected LMCA stenosis with DES stents. We also sought to classify and define the various anatomical variations of LMCA stenosis.
Total of forty one consecutive patients with LMCA stenosis underwent stenting in our institution. To define the location and complexity of LMCA disease lesions, we devised the classification of LMCA. DeLago’s LMCA stenosis classification includes 4 types and three classes (Figure 1). Different stenting techniques were used based on location of lesions. Patients were followed for the first three months. A repeat coronary angiogram was requested routinely after six months.
Mean age was 67+14 with range of 28 to 90. Forty-four percent were males; 28% were smoker; 72% had HTN; 75 % had DM; and 68 hypercholestremia. Fifty- six percent presented as UA, 8% as recent acute MI and 36 % had abnormal stress test. Initial procedural success rate was 100%. At 30 days follow-up was 0%. MI (Non Q wave) 4.8%. At 30-day follow-up, CVA, TVR, CABG and death outcomes were 0%. Mortality at three months was 2.4%.
Conclusion: Stenting of the unprotected LMCA stenosis provided excellent immediate result. Unprotected LMCA stenosis can be treated safely and effectively with DES coated stent and may be an effective strategy for treatment of LMCA disease in certain subset patient.
Our classification of LMCA stenosis helps to understand the complexity of the lesions and based on that various stenting technique like direct stenting, stent into the branch with osteal lesion and dilation of the other branch if needed, kissing stents, Culottes stenting and V stent technique can be used. Certainly Type 1 and Type 2 lesion are technically easy to stent and Type 3AC, Type 4 AC are very challenging and technically complex to do.
Narpinder Singh, None.