Single-stent crossover technique from distal unprotected left main coronary artery to the left circumflex artery

Abstract

Objectives: To report the clinical outcomes of single-stenting from distal unprotected left main coronary artery (LMCA) to the left circumflex artery (LCx).

Background: Percutaneous coronary intervention of distal LMCA is usually performed by stenting into the left anterior descending artery (LAD). In some cases, stenting from LMCA to LCx alone is performed.

Methods: Between April 2002 and April 2011, single-stenting with drug-eluting stents for distal unprotected LMCA disease was performed in 584 patients. Thirty-one patients underwent LMCA-LCx stenting, who were compared with the remaining 553 LMCA-LAD stented patients.

Results: At 3-year follow-up, there were no significant differences between LMCA-LCx and LMCA-LAD stenting groups in major adverse cardiac events (24.1% vs. 19.6%; P = 0.540), cardiac death, and myocardial infarction. A trend toward higher target lesion revascularization (TLR) in the LMCA-LCx stenting group was noted. This was significant when the stented branch was only considered (18.2% vs. 3.0%; P < 0.001). In both TLR subgroups, LCx ostium was frequently involved (83.3% in LMCA-LCx vs. 66.2% in LMCA-LAD TLR subgroups; P = 0.39). The LAD ostium was more frequently involved in LMCA-LCx TLR subgroup (83.3% vs. 21.0%; P < 0.001). On the multivariable Cox regression analysis, LMCA-LCx stenting was an independent predictor of TLR for restenosis at the ostium of the stented branch (HR 6.49; 95% CI 2.27-18.53; P < 0.001).

Conclusions: TLR rate at the LCx ostium is high irrespective of LMCA-LCx or LMCA-LAD stenting. The former also seems to be associated with high TLR at the LAD ostium. It may therefore be important to evaluate alternative strategies for treating distal LMCA disease that extends into the LCx but not LAD.

Keywords: coronary bifurcation; drug-eluting stent; left main coronary disease.