Samir Rafla*, Amr Zaki, Mohamed Ibrahim Loutfi, Mohamed Ahmed Sadaka, Moataz Shebl
Background: The results of stenting the Unprotected Left Main Coronary Artery (UPLM) without IVUS needs to be studied.
Methods: This prospective and retrospective study was performed in the university hospitals. The local ethics committee approved the study. In the last five years, one hundred twenty patients with left main disease > 50% were subjected to stenting with drug-eluted stents. Risk assessment was calculated including Euro SCORE and Syntax score.
Patient selection: Consecutive patients arriving for primary Stenting or acute coronary episode were included.
Medications: All patients received clopidogrel and aspirin before the planned procedure. Anticoagulation with unfractionated heparin in a dose of 10000 IU was given at the beginning of the PCI. Calcification was assessed by angiographic imaging only. We estimated the vessel diameter as 2/3 diameter of the branches. One or two stent strategy was utilized according to the situation of the lesions.
Results: 92 patients (77.3%) presented with ACS, of which 65 patients (54.6%) had no Previous Intervention, and 27 patients (22.7%) had a previous PCI. Left ventricular ejection fraction significantly correlates with the complication at six months follow-up.
Syntax score: 11 patients (55%) with a high score of more than 32 had adverse events, P=0.004. Residual syntax shows a less significant correlation (P=0.016). Final kissing balloon inflation shows no statistically significant difference.
Conclusions: PCI in UPLM is a safe, feasible option with a high technical success rate and acceptable outcome at follow-up, even without the utilization of IVUS.