Subang Jaya Medical Centre, Department of Cardiology, Subang Jaya, Malaysia.
Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia.
Med J Malaysia. 2023 Mar;78(2):139-144.
Intravascular ultrasound (IVUS) is recommended in the use of left main stem (LMS) percutaneous coronary intervention (PCI). Since the LMS diameter is usually larger than other coronary arteries, a new generation everolimus drug-eluting stent (DES), Synergy Megatron DES (Boston Scientific) has better axial and radial strength allowing more post implant overexpansion and consequently better suited for LMS lesions. We performed a study to evaluate the clinical outcomes of PCI using 1) an improved IVUS protocol with optimisation targets and 2) the use of Megatron stents.
This was a study involving LMS PCI coronary lesions using the Synergy Megatron DES. An IVUS protocol using predefined optimisation targets to evaluate for stent malapposition, longitudinal stent deformation, optimal stent expansion >90% of reference lumen and appropriate distal landing zone was used in all cases. The primary end-point was procedural success, defined by successful stent implantation with <30% residual stenosis. The secondary end-point was in-hospital and 30-day major adverse cardiovascular event (MACE).
Eight patients with significant LMS stenosis were successfully treated with the Megatron stent. The primary end-point was achieved in all patients. There were no cases of stent malapposition or longitudinal stent deformation, one case did not have optimal LMS stent expansion and one case did not have an appropriate distal landing zone. IVUS optimisation criteria were met in 6 (75%) cases. There were no complications of coronary dissection, slow or no reflow, stent thrombosis or vessel perforation. None of the patients suffered in-hospital or 30-day MACE. The average LMS MLD at baseline was 2.1 ± 0.1mm and the post-PCI LMS MLD was 4.0 ± 0.5mm, with a significant acute luminal gain of 1.9 ± 0.7mm (p<0.01). A post-PCI MSA of 17 ± 3.9 mm2 was numerically superior compared to those documented in other LMS PCI trials.
This study demonstrates low rates of shortterm major adverse cardiovascular events among patients with LMS PCI using the Megatron stents. It highlights the usefulness of IVUS-guided optimisation in LMS PCI. With the use of intravascular imaging, the new generation stent technology can improve the treatment of large proximal vessels and PCI of LMS lesions.
血管内超声（IVUS）推荐用于左主干（LMS）经皮冠状动脉介入治疗（PCI）。由于 LMS 直径通常大于其他冠状动脉，新一代依维莫司药物洗脱支架（DES）——Synergy Megatron DES（波士顿科学）具有更好的轴向和径向强度，允许更多的植入后过度扩张，因此更适合 LMS 病变。我们进行了一项研究，评估使用 1）改良 IVUS 方案和优化目标和 2）使用 Megatron 支架进行 PCI 的临床结果。
这是一项涉及使用 Synergy Megatron DES 治疗 LMS PCI 冠状动脉病变的研究。所有病例均使用 IVUS 方案，该方案使用预设的优化目标来评估支架贴壁不良、支架纵向变形、>90%参考管腔的最佳支架扩张和适当的远端着陆区。主要终点是程序成功，定义为成功植入支架，残余狭窄<30%。次要终点是住院期间和 30 天主要不良心血管事件（MACE）。
8 例 LMS 狭窄严重的患者成功接受 Megatron 支架治疗。所有患者均达到主要终点。无支架贴壁不良或支架纵向变形，1 例未达到最佳 LMS 支架扩张，1 例未达到适当的远端着陆区。6 例（75%）符合 IVUS 优化标准。无冠状动脉夹层、慢或无再流、支架血栓形成或血管穿孔等并发症。无患者发生住院期间或 30 天 MACE。基线时 LMS MLD 平均为 2.1±0.1mm，PCI 后 LMS MLD 为 4.0±0.5mm，急性管腔获得 1.9±0.7mm（p<0.01）。术后 MSA 为 17±3.9mm2，与其他 LMS PCI 试验相比具有数值优势。
本研究表明，在使用 Megatron 支架进行 LMS PCI 的患者中，短期主要不良心血管事件发生率较低。它强调了 IVUS 引导的优化在 LMS PCI 中的有用性。随着血管内成像技术的应用，新一代支架技术可以改善大近端血管的治疗和 LMS 病变的 PCI。
