Serial angiographic follow-up of sirolimus-eluting stents for unprotected left main coronary artery revascularization

J Am Coll Cardiol. 2006 Feb 21;47(4):871-7. doi: 10.1016/j.jacc.2005.12.015. Epub 2006 Jan 6.


Objectives: This study was performed to evaluate the clinical and serial angiographic outcomes of patients undergoing sirolimus-eluting stent (SES) implantation for unprotected left main coronary artery (LMCA) stenosis.

Background: The efficacy of SES has led to their expanded use for off-label indications, including LMCA disease.

Methods: Unprotected LMCA intervention with SES was attempted in 50 patients. Surveillance angiography was performed at three and nine months' follow-up.

Results: The target lesion involved the distal LMCA in 47 patients (94%). In-lesion restenosis occurred in 21 patients (42%), was focal in 85% of cases, and in 82% involved the branch ostia, sparing the LMCA itself. Target lesion revascularization (TLR) occurred in 19 patients (38%) over a mean follow-up of 276 +/- 57 days; TLR was ischemia-driven in 7 patients (14%). Late loss was significantly greater within the left circumflex (LCX) ostium compared to the parent vessel (PV) of the LMCA bifurcation (0.83 +/- 0.89 mm vs. 0.49 +/- 0.72 mm, p = 0.04). Late loss continued to increase between three- and nine-month follow-up. Final minimal luminal diameter and maximal balloon pressure were independent predictors of restenosis of the PV.

Conclusions: Restenosis is a frequent finding when serial angiographic follow-up is performed after SES implantation for unprotected distal LMCA lesions. Restenosis is usually focal, most often involves the LCX ostium, and often occurs without symptoms.

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary*
  • Cardiovascular Diseases / mortality
  • Coronary Angiography*
  • Coronary Restenosis / prevention & control
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / therapy*
  • Female
  • Humans
  • Male
  • Sirolimus / administration & dosage*
  • Stents*


  • Sirolimus