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Drug-eluting stents for the percutaneous treatment of the anastomosis of the left internal mammary graft to left anterior descending artery

Zavalloni, Dennisa; Rossi, Marco L.a; Scatturin, Melaniaa; Morenghi, Emanuelaa; Soregaroli, Danielaa; Municino, Annamariab; Gasparini, Gabriele L.a; Lisignoli, Veronicaa; Barbaro, Cristinaa; Presbitero, Patriziaa

doi: 10.1097/MCA.0b013e3282cf4ba9
Therapy and Prevention
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Background Data on the treatment of left internal mammary to left anterior descending artery (LIMA-to-LAD) anastomotic disease are scarce and not homogeneous. Both surgery and percutaneous interventions (PCI) have been attempted, but the most effective treatment has not yet been established. In particular, should PCI be performed, the role of stenting seems to be limited by less favorable results than in other subsets of lesions.

Objective To assess the clinical impact of drug-eluting stent (DES) use in this particular subset of lesions.

Methods We describe a cohort of patients treated with PCI on LIMA-to-LAD anastomoses, reporting acute 1-year clinical and angiographic outcomes. The clinical impact of DES use was evaluated as the requirement for target lesion revascularizations (TLR).

Results Fifty-six consecutive patients were evaluated. Acute procedural success was achieved in 52 patients (92.8%). Plain balloon angioplasty allowed acute procedural success in 15 patients (28.8%), whereas stenting was required in 37 patients (71.2%) with suboptimal results or to treat complications. Bare-metal stents (BMS) were used in 17 and DES in 20 patients, without differences in acute results. One-year clinical follow-up was available in 96.1% of patients. TLR were needed in 17.3% of patients. No significant differences were detected in TLR rates after treatment with BMS and DES (26.6% vs. 25%; P=0.99). Two late stent thromboses were observed after DES deployment.

Conclusion PCI of the stenoses of LIMA-to-LAD anastomoses with DES did not provide any clinical improvement over BMS use in long-term outcomes; DES use was associated with some cases of late thrombosis.

aInvasive Cardiology Department

bClinical Cardiology 2nd Department, Istituto Clinico Humanitas, IRCCS, Rozzano (Milano), Italy

Correspondence to Dr Dennis Zavalloni, MD, Unità Operativa di Emodinamica e di Cardiologia Invasiva, Istituto Clinico Humanitas, Via Manzoni, 56, 20089, Rozzano (Milano), Italy

Tel: +39 02 82243601; fax: +39 02 82243690;

e-mail: dennis.zavalloni_parenti@humanitas.it

Received 13 March 2007 Revised 25 May 2007 Accepted 6 June 2007

© 2007 Lippincott Williams & Wilkins, Inc.