Elective Coronary Angioplastics of the Unprotected Shaft of theLeft Coronary Artery

Overview

Background.
PTCA of the left main stem is an alternative therapy to coronary artery bypass grafting for left mainstenosis.Methods and Results. For the retrospective analysis, 32 consecutive patients referred for left main PTCA wereselected. Patients were subdivided into 2 groups. Group I consisted of 17 patients with no concomitant disease andwith good left ventricular function, where CABG was an alternative strategy. 15 patients of the group II were patientstowhom bypass was contraindicated for cardiac or extracardiac reasons (malignancy, poor LVfunction, non graftable)and they were recommended for the palliative treatment of their angina symptoms. We observed 100 % proceduralsuccess rate of the PTCA in both groups. There was no mortality at 6-month follow up among patients of the groupI and 13 % clinical restenosis rate at 6 months. In patients of the group II there was total 6-month mortality 26,6 %,all due to causes unrelated to procedure or coronary ischaemia (progression of malignancy, intractable heart failure).Conclusions. PTCA to left main stem represents an alternative treatment to aortocoronary bypass in cases offavourable anatomy with high procedural success and no 6-month mortality in patients with good LV function. Inpatients inwhom CABG is contraindicated, PTCA can be used as a palliative strategy in abating ischaemic symptoms.In this group, short-term prognosis relates to concomitant cardiac or extracardiac disease.

Key words:
left main stem, coronary artery disease, PTCA.