Sirolimus-eluting stent treatment for complex proximal left anterior descending artery stenoses: 7-month clinical and angiographic results.

BACKGROUND: High-grade involvement of the proximal left anterior descending artery (LAD), either in isolation or as part of multivessel coronary artery disease, remains a frequent indication for surgical revascularization. This is particularly true in complex proximal LAD lesions among high-risk patients, since stenting is usually ineffective in the long term as regards freedom from angina and target vessel revascularization (TVR) in such patient subsets. The sirolimus-eluting stent (SES) has been reported to significantly reduce clinical and angiographic restenosis rates. We therefore analyzed the clinical and angiographic long-term results of a group of complex patients treated with SES for proximal LAD stenoses.
METHODS: A total of 80 consecutive patients treated with sirolimus-eluting stents (SES) for complex proximal LAD stenoses were analyzed. This high-risk cohort included diabetic patients, long, bifurcated, ostial and heavily calcified lesions, chronic total occlusions and in-stent restenoses. Late lumen loss and clinically-driven target lesion revascularization (TLR) were analyzed at 7 months.
RESULTS: Late lumen loss was 0.19 +/- 0.06 mm in the analysis segment (stent with 5 mm proximal and distal to it) at 7 months. TLR was performed in 6.3% of cases, and the combined rate of death from any cause, nonfatal MI and TLR was also 6.3% at 7 months.
CONCLUSION: SES, once successfully implanted into complex proximal LAD stenoses, appear effective, with rather acceptable rates of adverse events at 7-month follow-up. Accordingly, treating the proximal LAD using SES in complex patients may narrow the gap between PCI and surgery for this indication.