EBC - ON DEMAND
Randomized Trial of Bare Metal and Drug-Eluting Stents for Unprotected Left Main Lesions An Update
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
HYPOTHESIS
- 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”
BACKGROUND
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