Technical feasibility, safety, and clinical outcome of stenting of unprotected left main coronary artery bifurcation narrowing

Am J Cardiol. 2002 Aug 15;90(4):374-8. doi: 10.1016/s0002-9149(02)02492-x.


This study was performed to evaluate the acute and long-term results of stenting for unprotected left main coronary artery (LMCA) bifurcation lesions. Sixty-three consecutive patients with an unprotected LMCA bifurcation lesion and normal left ventricular function were included. Stenting was performed with (n = 32) or without debulking atherectomy (n = 31) at the operator's discretion. Slotted-tube stents, coil stents, or bifurcation stents were used. The procedural success rate was 100%. In-hospital events including stent thrombosis, Q-wave myocardial infarction, and emergency bypass surgery did not occur in any patients. The angiographic follow-up rate was 86% (43 of the 50 eligible patients), and the restenosis rate was 28% (parent vessel only 14%, side branch only 9%, and both 5%). Restenosis at the parent vessel occurred less frequently in the debulking group than in the nondebulking group (5% vs 33%, respectively, p = 0.02). In multivariate analysis, the debulking procedure was an independent predictive factor of restenosis for the parent vessel (odds ratio 0.10, 95% confidence intervals 0.01 to 0.91, p = 0.04). Clinical follow-up was obtained in all patients at 19.9 +/- 13.7 months. There were 2 deaths (noncardiac origin), but no myocardial infarction during follow-up. Target lesion revascularization was required in 6 patients. The event-free survival rate (death, nonfatal myocardial infarction, and repeat revascularization) was 86% at the end of the follow-up period. In conclusion, stenting for an unprotected LMCA bifurcation lesion may be performed with a high procedural success rate and a favorable clinical outcome in selected patients with normal left ventricular function, suggesting that stenting would be an effective alternative to surgery in these patients.

Publication types

  • Evaluation Study

MeSH terms

  • Angioplasty, Balloon, Coronary / methods*
  • Atherectomy, Coronary*
  • Chi-Square Distribution
  • Combined Modality Therapy
  • Coronary Artery Disease / pathology
  • Coronary Artery Disease / therapy*
  • Coronary Restenosis / prevention & control
  • Coronary Vessels / pathology
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Regression Analysis
  • Stents*
  • Treatment Outcome