BRIEF REPORTS
Stenting for Elastic Recoil During Coronary Angioplasty of the Left Main Coronary Artery Carlos Macava, MD, Fernando Alfonso, MD, AndrCs Ifliguez, MD, Javier Goicolea, MD, Rosa Hernaidez, MD, and Pedro Zarco, MD onventional percutaneoustransluminal coronary angioplasty (PICA) of the left main coronary artery C (LMCA) constitutesa therapeutic challengebecauseit is associated with significant immediate morbidity and mortality and a high restenosisrate.i-4 Specialdifficulties may arise during PTCA of ostial LMCA lesionsincluding technical problems concerning precise balloon location and the possibleappearanceof elastic recoil despite the useof adequate-sizedballoons4 We report 3 patients with “unprotected” ostial lesionsof the LMCA in whom significant elastic recoil after RCA was successfully managed with coronary stenting. In each patient the strategy for stent deployment consisted in leaving the proximal edge of the stent slightly protruding into the aortic root. This was successfullyaccomplishedand sub sequently confirmed in the 3 cases. Of 10 consecutive patients undergoing conventional balloon PTCA of the LMCA in our institution, 3 required a stent implantation (Palmaz-Schatz) for elastic recoil of an ostial LMCA lesion. Baseline characteristics of these 3 patients are summarized in Table I. The 3 patients had refractory angina at rest despite multiple attempts to optimize medical therapy. All patients were at a prohibitive surgical risk.4*5 Patient 1 had a terminal epidermoid carcinoma of the lung. Patient 2 was in refractory cardiogenic shock, resulting from an early occlusion of a saphenous bypass graft to the left anterior descending coronary artery which caused a perioperative anterior myocardial infarction. Patient 3 had previously undergone 3 cardiac interventions including an open mitral valve commissurotomy followed by 2 mitroaortic valve replacements for severe rheumatic valve disease (the last 6 months before, with implantation of 2 St. Jude [nos. 25 and 211 prostheses). A long recoveryperiod with difficulties to wean the patient off from the mechanical ventilator and an associated mediastinitis Department of Cardiopulmonar, Hospital Universitario San Carlas, Ciudad Universitaria, Plaza de Cristo Rey, Madrid 28040,Spain. Manuscript received January 6, 1992;revised manuscript receivedand accepted February 27,1992.
complicated this intervention and, subsequently, he was admitted again for bifemoral bypass grafting. In every patient PTCA of the unprotected LMCA was eventually considered the therapy of choice. Lesion narrowing was measured with electronic calipers from a digital automatic angiographic system (Phillips DCI). All patients had severe stenosis of the ostium of the LMCA (Figures 1 to 3). Intracoronary nitroglycerine (0.2 mg) was administered before the procedure. A balloon PTCA was initially attempted in every case. A perfusion balloon (Stack) was used in patient 1, whereas patient 2 underwent PTCA while receiving percutaneous cardiopulmonary support (CPS, USCI-Bard). In this patient thepulsatile pressure wave morphology changed to a continuous lineal pressure of 75 mm Hg during balloon inflation. Aortobifemoral bypass grafting prevented the use of cardiopulmonary support in patient 3. During PTCAs care was taken to use short inflation times (
Stenting for Elastic Recoil During Coronary Angioplasty of the Left Main Coronary Artery Carlos Macava, MD, Fernando Alfonso, MD, AndrCs Ifliguez, MD, Javier Goicolea, MD, Rosa Hernaidez, MD, and Pedro Zarco, MD onventional percutaneoustransluminal coronary angioplasty (PICA) of the left main coronary artery C (LMCA) constitutesa therapeutic challengebecauseit is associated with significant immediate morbidity and mortality and a high restenosisrate.i-4 Specialdifficulties may arise during PTCA of ostial LMCA lesionsincluding technical problems concerning precise balloon location and the possibleappearanceof elastic recoil despite the useof adequate-sizedballoons4 We report 3 patients with “unprotected” ostial lesionsof the LMCA in whom significant elastic recoil after RCA was successfully managed with coronary stenting. In each patient the strategy for stent deployment consisted in leaving the proximal edge of the stent slightly protruding into the aortic root. This was successfullyaccomplishedand sub sequently confirmed in the 3 cases. Of 10 consecutive patients undergoing conventional balloon PTCA of the LMCA in our institution, 3 required a stent implantation (Palmaz-Schatz) for elastic recoil of an ostial LMCA lesion. Baseline characteristics of these 3 patients are summarized in Table I. The 3 patients had refractory angina at rest despite multiple attempts to optimize medical therapy. All patients were at a prohibitive surgical risk.4*5 Patient 1 had a terminal epidermoid carcinoma of the lung. Patient 2 was in refractory cardiogenic shock, resulting from an early occlusion of a saphenous bypass graft to the left anterior descending coronary artery which caused a perioperative anterior myocardial infarction. Patient 3 had previously undergone 3 cardiac interventions including an open mitral valve commissurotomy followed by 2 mitroaortic valve replacements for severe rheumatic valve disease (the last 6 months before, with implantation of 2 St. Jude [nos. 25 and 211 prostheses). A long recoveryperiod with difficulties to wean the patient off from the mechanical ventilator and an associated mediastinitis Department of Cardiopulmonar, Hospital Universitario San Carlas, Ciudad Universitaria, Plaza de Cristo Rey, Madrid 28040,Spain. Manuscript received January 6, 1992;revised manuscript receivedand accepted February 27,1992.
complicated this intervention and, subsequently, he was admitted again for bifemoral bypass grafting. In every patient PTCA of the unprotected LMCA was eventually considered the therapy of choice. Lesion narrowing was measured with electronic calipers from a digital automatic angiographic system (Phillips DCI). All patients had severe stenosis of the ostium of the LMCA (Figures 1 to 3). Intracoronary nitroglycerine (0.2 mg) was administered before the procedure. A balloon PTCA was initially attempted in every case. A perfusion balloon (Stack) was used in patient 1, whereas patient 2 underwent PTCA while receiving percutaneous cardiopulmonary support (CPS, USCI-Bard). In this patient thepulsatile pressure wave morphology changed to a continuous lineal pressure of 75 mm Hg during balloon inflation. Aortobifemoral bypass grafting prevented the use of cardiopulmonary support in patient 3. During PTCAs care was taken to use short inflation times (
