Park S J, Park S W, Hong M K, Cheong S S, Lee C W, Kim J J, Hong M K, Mintz G S, Leon M B
Department of Internal Medicine, College of Medicine, University of Ulsan, and Asan Medical Center, Seoul, Korea.
J Am Coll Cardiol. 1998 Jan;31(1):37-42. doi: 10.1016/s0735-1097(97)00425-7.
We examined the immediate and long-term outcomes after stenting of unprotected left main coronary artery (LMCA) stenoses in patients with normal left ventricular (LV) function.
Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty. Recently, several reports on protected or unprotected LMCA stenting, or both, suggested the possibility of percutaneous intervention for this prohibited area.
Forty-two consecutive patients with unprotected LMCA stenoses and normal LV function were treated with stents. The post-stent antithrombotic regimens were aspirin and ticlopidine; 14 patients also received warfarin. Patients were followed very closely with monthly telephone interviews and follow-up angiography at 6 months.
The procedural success rate was 100%, with no episodes of subacute thrombosis regardless of anticoagulation regimen. Six-month follow-up angiography was performed in 32 of 34 eligible patients. Angiographic restenosis occurred in seven patients (22%, 95% confidence interval 7% to 37%); five patients subsequently underwent elective coronary artery bypass graft surgery (CABG), and two patients were treated with rotational atherectomy plus adjunct balloon angioplasty. The only death occurred 2 days after elective CABG for treatment of in-stent restenosis. The other patients (without angiographic follow-up) remain asymptomatic.
Stenting of unprotected LMCA stenoses may be a safe and effective alternative to CABG in carefully selected patients with normal LV function. Further studies in larger patient populations are needed to assess late outcome.
我们研究了左心室（LV）功能正常的患者非保护左主干冠状动脉（LMCA）狭窄支架置入术后的即刻和长期结果。
左主干冠状动脉疾病被视为冠状动脉血管成形术的绝对禁忌证。最近，几篇关于保护或非保护LMCA支架置入术或两者皆有的报道提示了对这个禁区进行经皮介入治疗的可能性。
连续42例非保护LMCA狭窄且LV功能正常的患者接受了支架治疗。支架置入术后的抗血栓治疗方案为阿司匹林和噻氯匹定；14例患者还接受了华法林治疗。通过每月电话随访和6个月时的随访血管造影对患者进行密切随访。
手术成功率为100%，无论抗凝方案如何，均未发生亚急性血栓形成事件。34例符合条件的患者中有32例进行了6个月的随访血管造影。7例患者（22%，95%可信区间7%至37%）发生了血管造影再狭窄；5例患者随后接受了择期冠状动脉旁路移植术（CABG），2例患者接受了旋磨术加辅助球囊血管成形术治疗。唯一的死亡发生在择期CABG治疗支架内再狭窄术后2天。其他患者（未进行血管造影随访）仍无症状。
对于精心挑选的LV功能正常的患者，非保护LMCA狭窄支架置入术可能是CABG的一种安全有效的替代方法。需要在更大的患者群体中进行进一步研究以评估晚期结果。
