Vol. 3, Issue 4 (2014)

Author(s):
Slobodan Antov, Sasko Kedev, Oliver Kalpak, Ivan Vasilev, Valon Asani, Jorgo Kostov, Igor Spiroski, Hristo Pejkov

Abstract:
Introduction: A Significant unprotected left main coronary artery (ULMCA) disease occurs in 3–9% of all patients who undergo coronary angiography [1], and it is regarded as the most prognostically important coronary lesion because of the extent of jeopardized myocardium.
Purpose: To assess the safety and efficacy of using trans-radial approach (TRA) for percutaneous coronary intervention (PCI) and stenting of left main coronary artery (LMN) with over 80% stenosis in symptomatic patients.
Methods: We evaluated clinical outcomes of 170 consecutive patients with LM stenting in period between January 2007 and March 2014. The follow up period was 6 months. The baseline characteristics of the study group were: mean age was 62±10.3 years. Males were 133(78%). Acute coronary syndrome (ACSy) was present in 141(83%) of patients. Patients with ST-segment elevation (STEMI) were 27(16%), and non-STEMI in 19 (11%) and unstable angina (UA) in 93(55%). Cardiogenic shock was present in 2 patients (1.17%).
Results: Trans-radial access was used in 151(89%) of patients, trans-ulnar (TUA) in 10(6%) TFA in 9(5%), using 5F and 6F guiding catheters. Drug-eluting stents were used in 131(77%) of patients treated with standard medication regiment. GP IIB/IIIA inhibitors were administrated only in 7(4%) patients. All procedures were achieved with TIMI 3 flow. Ten patients (6%) died during hospital stay and there was no additional deaths during 6 months follow up period. Nine deaths (5%) were cardiac and one (1,7%) was dye severe gastric bleeding.
Conclusion: Trans-radial stenting of diseased and symptomatic left main is feasible and safe when were performed by experienced high-volume operators. Selection, evaluation of the patient as well as planning of the procedure is crucial.