Korean J Intern Med.  2014 Sep;29(5):597-602. 10.3904/kjim.2014.29.5.597.

Long-term outcomes of simple crossover stenting from the left main to the left anterior descending coronary artery

• Lee HM
• Nam CW
• Cho YK
• Yoon HJ
• Park HS
• Kim H
• Chung IS
• Heo YS
• Hur SH
• Kim YN
• Kim KB

• KMID: 1794624
• DOI: http://doi.org/10.3904/kjim.2014.29.5.597

Abstract

BACKGROUND/AIMS
Although complex bifurcation stenting in patients with non-left main (LM) bifurcation lesions has not yielded better clinical outcomes than simpler procedures, the utility of complex bifurcation stenting to treat LM bifurcation lesions has not yet been adequately explored.
METHODS
In the present study, patients who underwent LM-to-left anterior descending (LAD) coronary artery simple crossover stenting to treat significant de novo distal LM or ostial LAD disease, in the absence of angiographically significant ostial left circumflex (LCX) coronary artery disease, were consecutively enrolled. The frequencies of 3-year major adverse cardiovascular events (MACEs; cardiac death, myocardial infarction, and target lesion revascularization), were analyzed.
RESULTS
Of 105 eligible consecutive patients, only 12 (11.4%) required additional procedures to treat ostial LCX disease after main vessel stenting. The mean percentage diameter of ostial LCX stenosis increased from 22.5% +/- 15.2% to 32.3% +/- 16.3% (p < 0.001) after LM-to-LAD simple crossover stenting. The 3-year incidence of MACEs was 9.7% (cardiac death 2.2%; myocardial infarction 2.2%; target lesion revascularization 8.6%), and that of stent thrombosis 1.1%. Of seven cases (7.5%) requiring restenosis, pure ostial LCX-related repeat revascularization was required by only two.
CONCLUSIONS
Simple crossover LM-to-LAD stenting without opening of a strut on the LCX ostium was associated with acceptable long-term clinical outcomes.

Keyword

Percutaneous coronary intervention; Coronary stenosis; Stents; Outcome

MeSH Terms

Aged
Coronary Artery Disease/*therapy
Coronary Restenosis/etiology
Coronary Stenosis/therapy
Disease-Free Survival
*Drug-Eluting Stents
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention/adverse effects/*methods
Treatment Outcome