Isolated disease of the ostium left anterior descending or circumflex artery: management using a left main stenting technique. Clinical outcome at 2 years.

Background: Ostial disease of the left anterior descending (LAD) or circumflex (LCX) coronary artery is a challenge for the interventionalist. Focal ostial stenting may result in incomplete lesion coverage or plaque shift into the adjacent vessel, creating left main equivalent disease. The purpose of the present study was to address these concerns by using a left main bifurcation strategy with drug-eluting stents (DES) for the treatment of this problem.

Methods: The study population consisted of patients with isolated unprotected ostial stenosis of the LAD or LCX artery. Coronary stenting was performed using a bifurcational technique in which DES were deployed from the distal left main artery across the stenosis into the main branch. Post-deployment kissing balloon inflation with provisional side branch stenting was then performed. Clinical and angiographic follow up was obtained to assess the primary endpoint of death, non-fatal myocardial infarction (MI) or target lesion revascularization (TLR).

Results: Thirty-three patients (19 males, 14 females) with a mean age of 67 years were evaluated. Clinical follow up was available in all patients; the mean duration of follow up was 24 months. One cardiac death and 1 non-fatal MI occurred. Protocol-driven follow-up angiography with intravascular ultrasound (IVUS) was obtained at a mean of 11 months in 91% of patients. The incidence of TLR was 15%.

Conclusion: Main branch stenting with post-stent deployment kissing balloon inflations and provisional side branch stenting may be a reasonable option for the treatment of ostial LAD or LCX disease.