European Bifurcation Club 2008 – EBC 2008 – Prague, Czech Republic
LM stenting or surgery ?
Randomized Trial of Bare Metal and Drug-Eluting Stents for Unprotected Left Main Lesions An Update
Author: Andrejs Erglis, MD, Latvian Centre of Cardiology, Latvian Society of Cardiology, Riga, Latvia
- Plaque modification before stent deployment may minimize arterial injury and subsequent neointimal proliferation and may prevent restenosis formation:
- it minimizes plaque shifting between main branch and side branch and thus helps avoiding side branch stenting
- it gives perfect stent apposition with reduced inflation pressure even if very long stents are deployed
- in the future when bioabsorbable stents will be available it can be an essential tool to perform complete “vessel repair procedures”
To optimize PCI strategy for unprotected LM disease, we performed a randomized study: IVUS- guided BMS or paclitaxel-eluting stent (PES) implantation after lesion preparation with cutting balloon (CB) for unprotected LM lesions.
CONCLUSION 6 MONTHS
- The current study demonstrates that PCI on LM with IVUS guidance and CB pre- treatment is safe and effective. No serious procedure-related complications were observed and clinical outcomes appeared to be good.
- The findings of this study demonstrate that implantation of PES may be superior to BMS in the large diameter LM at six months, warranting the performance of a large scale randomized trial
CONCLUSION 3 YEARS
- The findings of preliminary results of long- therm follow-up demonstrates significant benefit for PES in therms of IVUS parameters
- IVUS data are not yet converting in clinical outcomes
- Complete follow-up data is needed