Elective coronary angioplasty in the unprotected branch of the left coronary artery

BACKGROUND: PTCA of the left main stem is an alternative therapy to coronary artery bypass grafting for left main stenosis. METHODS AND RESULTS: For the retrospective analysis, 32 consecutive patients referred for left main PTCA were selected. Patients were subdivided into 2 groups. Group I consisted of 17 patients with no concomitant disease and with good left ventricular function, where CABG was an alternative strategy. 15 patients of the group II were patients to whom bypass was contraindicated for cardiac or extracardiac reasons (malignancy, poor LV function, non graftable) and they were recommended for the palliative treatment of their angina symptoms. We observed 100% procedural success rate of the PTCA in both groups. There was no mortality at 6-month follow up among patients of the group I and 13% clinical restenosis rate at 6 months. In patients of the group II there was total 6-month mortality 26.6%, all due to causes unrelated to procedure or coronary ischaemia (progression of malignancy, intractable heart failure). CONCLUSIONS: PTCA to left main stem represents an alternative treatment to aortocoronary bypass in cases of favourable anatomy with high procedural success and no 6-month mortality in patients with good LV function. In patients in whom CABG is contraindicated, PTCA can be used as a balliative strategy in abating ischaemic symptoms. In this group, short-term prognosis relates to concomitant cardiac or extracardiac disease.