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At least 127 records · Page 7Linked to original sources
PubMed1986

Prospective evaluation of the left main coronary artery using digital two-dimensional echocardiography.

Recent clinical studies emphasize the importance of identification of patients with left main coronary artery obstruction. Although two-dimensional echocardiography can detect left main coronary artery disease, the technique requires frame by frame analysis, as no single frame provides all the necessary information. To determine if newly available computer-based digital processing techniques could overcome some of these technical difficulties, 119 consecutive patients were prospectively evaluated with two-dimensional echocardiography before coronary angiography. A continuous loop recording of the left main coronary artery was recorded as it passed through the ultrasonic beam in the short-axis view. Starting at a point when the vessel was first visualized, the ensuing eight consecutive fields, each 17 ms apart, were captured in digital format, thus providing a series of parallel, sequential, longitudinal slices of the left main coronary artery as it traversed the imaging plane. This was successfully accomplished in 100 (84%) of the 119 consecutive patients. By angiography, 16 patients (16%) had greater than 50% narrowing of the left main coronary artery. Digital echocardiography correctly identified 15 of these 16 patients (94% sensitivity) and accurately localized the lesion in 12 (80%) of 15. Of 84 patients without significant left main coronary artery obstruction, digital echocardiography correctly identified 78 (93% specificity). It was concluded that computer-based digital processing techniques can be applied to two-dimensional echocardiography to allow reliable visualization of the left main coronary artery. The technique provides more information than a single still frame and allows accurate noninvasive detection and possible localization of left main coronary artery lesions.

Coronary Angiography↗
PubMed2003

The relationship between the diameters of the adult cricoid ring and main tracheobronchial tree: a cadaver study to investigate the basis for double-lumen tube selection.

OBJECTIVE: Previous investigation of the adult cadaver larynx has shown that the cricoid diameter never exceeds that of the glottis. This further analysis looks at the anatomic relationships between the diameter of the cricoid ring and those of the main tracheobronchial tree to discover how they relate to double-lumen tube selection. DESIGN: Prospective. SETTING: A city mortuary. PARTICIPANTS: Adult cadavers undergoing autopsy. INTERVENTIONS: The trachea was partially transected above the first ring to expose the cricoid cartilage from below and was then further opened with a progressive longitudinal incision to allow access to the tracheobronchial tree. MEASUREMENTS AND MAIN RESULTS: In 59 male and 49 female white cadavers, the largest of a graduated series of cylindrical sounds that the cricoid ring would accommodate was noted. They were then used to measure the maximum diameters of the main tracheobronchial tree. In both sexes, the mean diameter of the cricoid was shown to be the same as that of the left main bronchus, the left main bronchus to cricoid ratio almost invariably exceeded 83% (against the maximum double-lumen tube tip-to-body ratio of 80%), and the coefficient of correlation (r) between the cricoid and left main bronchial diameters was 0.6. For the trachea and left main bronchus, r was 0.5 in male cadavers and 0.45 in female cadavers. CONCLUSIONS: The dimensions of the cricoid ring best define those of the main bronchi. Knowing its diameter should assist anesthesiologists with double-lumen tube selection.

Aged↗
PubMed1995

Presence, completeness, and accuracy of main concepts in the connected speech of non-brain-damaged adults and adults with aphasia.

A standard rule-based system was used to evaluate the presence, accuracy, and completeness of main concepts in the connected speech of 20 non-brain-damaged adults and 20 adults with aphasia. Main concepts form a skeletal outline of the most important information (or "gist") in a message. The interjudge and intrajudge reliability of the main concept scoring system and the test-retest stability of scores were acceptable. The non-brain-damaged group produced significantly more Accurate/complete main concepts, and significantly fewer Accurate/incomplete, Inaccurate, and Absent main concepts than the group with aphasia. However, when the performance of individual subjects was evaluated, what best discriminated the performance of subjects with aphasia from that of non-brain-damaged subjects was not the number of main concepts they failed to mention but the accuracy and completeness of the main concepts they did produce. Measures of main concept production may be a clinically useful complement to other measures of communicative informativeness and efficiency.

Aged↗
PubMed2000

Surgical management of congenital obstruction of the left main coronary artery with supravalvular aortic stenosis.

OBJECTIVE: Stenosis of the left main coronary artery is a recognized complicating feature of supravalvular aortic stenosis. We have retrospectively identified three anatomic subtypes of left main coronary obstruction in patients with supravalvular aortic stenosis, each necessitating a distinct surgical approach. METHODS: From 1991 to 1998, 9 patients underwent surgical repair of supravalvular aortic stenosis and left main coronary stenosis. Five patients (group 1) had obstruction from near-circumferential thickening of the left main ostium, 2 patients (group 2) had restricted coronary flow due to fusion of an aortic valve leaflet to the supravalvular ridge, and 2 patients (group 3) had diffuse narrowing of the left main coronary artery. Group 1 patients were treated with patch aortoplasty encompassing the left main ostium and supravalvular aortic stenosis. Group 2 patients were treated with excision of the fused leaflet from the aortic wall and patch aortoplasty. Group 3 patients were treated with bypass grafting and aortoplasty. RESULTS: Surgical strategy was determined by coronary angiography and intraoperative assessment of coronary anatomy. There was 1 early death. All surviving patients underwent echocardiography with or without postoperative catheterization. The mean postoperative supravalvular gradient for 7 patients was 8 mm Hg (range 2-15 mm Hg). One patient required reoperation for a residual aortic gradient as a result of aortic arch involvement. No evidence of left main coronary artery stenosis was seen in groups 1 and 2; bypass grafts were patent in group 3 patients at a mean follow-up of 54.8 months. CONCLUSION: Three subtypes of left main coronary stenosis with supravalvular aortic stenosis are described. Each anatomic type mandates an individual surgical approach. Favorable surgical outcomes are achievable with each category.

Adolescent↗
PubMed2000

The influence of varying precompaction and main compaction profile parameters on the mechanical strength of compacts.

The purpose of this work was to investigate how altering the method of force application could be beneficial to tablet production in order to increase tablet strength and eliminate or minimize the incidence of capping and lamination. An integrated compaction research system (i.e., compaction simulator) was used throughout this study. Compaction profiles containing a single compaction event and a double (pre- and main) compaction event were created. The ratio and magnitude of the pre- and main compaction pressures were varied and the time interval between the pre- and main compaction events was altered to determine the effects on the crushing strengths and capping tendency of the final compacts. In all cases, for a given pressure, the double compaction event produced stronger tablets than the single compaction event. When the ratio and magnitude of the pre- and main compaction pressures were varied, the results differed depending on the material undergoing compaction. Dicalcium phosphate/microcrystalline cellulose and pregelatinized starch tablets had no significant difference in crushing strength values regardless of whether the precompaction pressure was less than or greater than the main compaction pressure. However, both direct compression (DC) acetaminophen and DC ibuprofen were found to have increased crushing strengths and decreased capping/lamination when the precompaction pressure was less than the main compaction pressure. When the time interval between the pre- and main compaction events was varied from 30 to 500 msec, no significant difference in the crushing strength or capping/lamination tendency was observed. It was concluded that the effect of altering the ratio and magnitude of the pre- and main compaction pressures varied from one material to another, suggesting that the profiles should be tailored individually for the specific material undergoing compaction.

Tablets↗
PubMed2003

Radiographic relationship of the origin of the bronchial arteries to the left main bronchus.

The purpose of this study was to demonstrate that the relationship of the left main bronchus to the bronchial arteries is a reliable radiographic landmark for accurate catheterization of the right and left bronchial arteries. Sixty-six bronchial angiograms and chest radiographs in 43 patients were reviewed. The relationship of the tip of the catheter during initial bronchial angiography (used as the point of bronchial arterial origin) and the radiolucent shadow of the left main bronchus in patients with and without radiographic evidence of anatomic distortion caused by pulmonary disease was categorized into three groups: within the shadow of the left main bronchus, near the left main bronchus, and far from the left main bronchus. The origin of the right and left bronchial arteries was within or near the shadow of the left main bronchus in 94% of bronchial angiograms performed in patients with and without distorted thoracic anatomy. The most frequent location was within the shadow of the left main bronchus. The left main bronchus can be used as a reliable reference point for catheterization of the right or left bronchial arteries in patients with and without thoracic anatomic distortion.

Adult↗
PubMed2000

Endoscopic treatment of the main pancreatic duct: correlations among morphology, manometry, and clinical follow-up.

BACKGROUND AND AIM: During the course of chronic pancreatitis, the gradual increase in the main pancreatic duct pressure is the main pathophysiological factor responsible for pain, but up to now, the intra ductal pressure has never been measured during and after endoscopic stenting and correlated with clinical results. Pressure measurements of this kind could thus provide objective information about the useful duration of stenting period. METHODS: Main pancreatic duct pressure was measured by performing endoscopic manometry on 13 chronic pancreatitis symptomatic patients (10 men, 3 women, mean age: 45.1+/-7.9 yr); clinical follow-up was carried out for a period of 29.0+/-16.1 mo. Before treatment, the main anatomical alteration present was a localized stenosis of the main pancreatic duct, i.e., one with a diameter of less than 2 mm (chronic pancreatitis alone), 10 cases; chronic pancreatitis associated with pancreas divisum, 3 cases). Stenosis was treated by endoscopic stenting: 7 F stent (7 cases) and 12 F stent (6 cases). The pressure was measured simultaneously in the duodenum (zero level) and within the main pancreatic duct, using an electronic device, The pancreatico-duodenal gradient was taken to be the difference between the pressure in the main pancreatic duct and the duodenum. RESULTS: The endoscopic stenting induced a nonsignificant decrease in the intraductal pressure (p = 0.16). Among the 9 patients with a normal pressure at the end of the stenting and a successful anatomical outcome, 6 were painless during the follow-up period whereas 3 presented with recurrent pancreatic-type pain. The remaining 4 patients were symptom-free during the entire follow-up period, although the main pancreatic duct pressure was high at the end of the stenting and the stenosis was not completely cured. CONCLUSION: The intraductal pressure at the end of the stenting period was perfectly correlated with the anatomical result, whether or not it was successful, but was not an accurate predictor of a favorable clinical outcome in patients with a poor anatomical result.

Adult↗
PubMed2002

Shift in Th1 (IL-2 and IFN-gamma) and Th2 (IL-10 and IL-4) cytokine mRNA balance within two new histological main-types of rheumatoid-arthritis (RA).

Cytokines are the main mediators of inflammation in rheumatoid arthritis (RA). Thus, Th2 cytokines--such as IL-4 and IL-10--have protective properties to this disease. In opposite, the Th1 cytokines--such as IL-2 and IFN-gamma--are supporting proinflammatory microenvironment in joints from patients with RA. The imbalance of Th1/Th2 cytokine steady state may play an important role in the pathogenesis of rheumatoid arthritis. The evaluation of this imbalance leads up to the possibility of pathohistological discrimination in this disease. In this context, we investigated Th1- (IFN-gamma, IL-2) and Th2 (IL-10, IL-4)-cell-derived cytokine mRNA expression in two novel pathohistological main-types of RA synovial membrane (SM). These main-types are characterized by different tissue-infiltrating inflammatory cells and different extent of SM destruction. Our findings showed that expression of IL-10 mRNA was an outcome of histological main-type I (p<0.001), whereas expression of IFN-gamma and IL-2 were mainly associated with pathohistological main-type II (p<0.005, p<0.05). Surprisingly, IL4 was not differential expressed and could be associated with another special T cell subset in this disease. These results suggest that Th1/Th2 balance is biased to Th2 cytokines within main-type I and Th1 cytokines in main-type II.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Histopathologic differentiation of the main nodule determines outcome after hepatic resection for synchronous multicentric hepatocellular carcinomas.

BACKGROUND/AIMS: Clinicopathological features and outcome after surgery in patients with synchronous multicentric hepatocellular carcinoma were examined in relation to the histopathological grade of differentiation of the main nodule. METHODOLOGY: Two hundred and sixty-five patients with synchronous multicentric hepatocellular carcinoma (total, 683 nodules) who had undergone curative hepatectomy from 1988 through 1999 were studied retrospectively. In multicentric occurrences of hepatocellular carcinoma, the tumor with the largest dimension was defined as the main nodule, and the others as accessory nodules. RESULTS: The histopathological grade of differentiation of the main nodule was assessed to be well differentiated in 72 patients (27.2%), moderately differentiated in 160 patients (60.4%), and poorly differentiated in 33 patients (12.4%). Tumor size of the main nodule was significantly smaller in patients with well differentiated hepatocellular carcinoma than in patients with moderately or poorly differentiated hepatocellular carcinoma. Alpha-fetoprotein levels were significantly lower in cases in which the main nodule was diagnosed to be well differentiated hepatocellular carcinoma than in other cases. The 5-year survival rate and recurrence-free survival rate were significantly greater in cases in which the main nodule showed well differentiated hepatocellular carcinoma (78.1% and 33.8%, respectively) than in other cases [moderately differentiated 49.0% (p<0.0001), 11.6% (P=0.0002); poorly differentiated 37.4% (p<0.0001), 8.3% (P=0.0002), respectively]. Multivariate analysis identified the histopathological grade of the main nodule as significant independent prognostic factors. CONCLUSIONS: There were differences in surgical outcome in relation to the histopathological grade of differentiation of the main nodule in patients with synchronous multicentric hepatocellular carcinoma.

Aged↗
PubMed2005

Assessment of pollution levels in fish and water of main basin, Lake Mariut.

Lake Mariut has suffered over the years from the untreated sewage, agricultural and industrial wastes dumped into it. Lake Mariut fish quality and quantity were adversely affected eventually being unfit for human consumption due to its poor water quality. The present study was carried out to evaluate the levels of metals in the fish caught from Lake Mariut main basin and its fitness for human consumption, and the water quality after the enforcement of the Egyptian Law for Environmental Protection (Law 4/1994). Fish and water samples were collected form Lake Mariut main basin through out the period from May to December 2000. The results showed that mercury was totally undetected in fish and water samples. The levels of Fe obtained were very low compared to previous studies. Fe and Cr contents in fish flesh were higher compared to their levels in water samples. Also Cu has shown a decrease in both fish and water samples. Zn and Cd contents in water samples have decreased compared with former studies. However, they have not changed in fish flesh. Pb content in both fish flesh and water samples has shown a great decrease compared to previous studies. The Cd and Pb mean values in fish flesh of the present study (0.81 and 0.14 mg/kg) exceeded the Egyptian Standards No. 2360/1993 value (should not exceed 0.1 mg/kg for each). The results also showed that the water quality has changed compared with previous studies. BOD has increased in north of Main Basin, east of Main Basin, South of Main Basin, and southwest of Main Basin; and deCreased in WTP effluent; and Qalaa Drain. There has been an increase in TSS, TVSS, and NO3 levels compared to pervious studies. There has been a decrease in TS, TDS, COD,hardness, and chloride levels. This decrease, especially in COD, may be attributed to the enforcement of the Egyptian Law 4/1994. The pH and alkalinity were in agreement with the values shown by previous studies except for east of Main Basin which showed higher values. The study included some recommendations aiming at improving both water quality and fish of the Main Basin.

Animals↗
PubMed1985

[Significance of the stress test for the diagnosis of stenosis of the left main coronary artery. Distinctly different results in relation to the degree of stenosis].

Coronary anatomy and the results of treadmill exercise testing were compared in two partially overlapping groups of patients. In the first part of the study, treadmill tests of 29 patients with significant (greater than or equal to 50%) left main stenosis were compared to those of 40 patients each with proximal 1-, 2-, and 3-vessel disease, respectively. Two distinct subgroups were identified among the patients with greater than or equal to 50% left main stenosis: Of those with greater than or equal to 70% left main stenosis all had a positive (ST decreases greater than or equal to 0.1 mV) stress test, 79% had a markedly positive (ST decreases greater than or equal to 0.2 mV) test and this group had the lowest exercise capacity. In patients with only moderate left main stenosis (50-70%) ST-segment depression was significantly less and occurred significantly later than in patients with severe left main stenosis and 3-vessel disease. Patients with 1-, and 2-vessel disease could be clearly separated from patients with either severe left main stenosis or 3-vessel disease, but not from those with only moderate left main stenosis. In the second part of the study the coronary anatomy of 62 patients with a markedly positive stress test was analysed. In these patients left main stenosis, 3-, 2-, and 1-vessel disease was observed in 10%, 50%, 23% and 16%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed2001

Extrinsic compression of the left main coronary artery by a dilated pulmonary artery: clinical, angiographic, and hemodynamic determinants.

Extrinsic compression of the left main coronary artery (LMC) by the pulmonary artery (PA) is a very unusual and poorly understood entity, usually associated with the presence of adult congenital heart disease. We identified 12 patients (age range, 6 months to 55 years) with LMC stenosis (> or = 50%) presumably secondary to compression by a dilated main PA and related to various forms of heart disease (11 congenital, 1 pulmonary hypertension). In all cases, the main PA was dilated with the main PA/aortic root diameter increased (mean, 2.0; normal value, < or = 1.0), and in all but two, PA pressures were increased (> 30 mm Hg systolic). Left coronary trunk stenosis was usually visualized in only one angiographic view (best seen in 45 degrees left anterior oblique, 30 degrees cranial projection). The LMC also appeared to be inferiorly displaced and in close contact with the left aortic sinus (mean angle between sinus and LMC was 23 degrees +/- 13 degrees, a control group was 70 degrees +/- 15 degrees ). In one patient, surgical correction of the dilated PA was associated with a reduction in LMC stenosis from 85% to < 50% and less inferior left main displacement (from 25 degrees to 50 degrees ). Patients with a dilated main PA may exhibit extrinsic LMC compression leading to significant eccentric narrowing and downward displacement of the LMC. In the presence of significant dilatation of the main PA from any etiology, functional and/or anatomic studies should be performed to exclude significant LM obstruction.

Adolescent↗
PubMed2005

Technique of left main stenting is dependent on lesion location and distal branch protection.

The purpose of this study was to review our experience with left main stenting and evaluate initial results with drug-eluting stents (DESs). Drug-eluting stents delivered with contemporary techniques could change the traditional surgical approach to patients with significant left main disease. One hundred sixty-one patients underwent left main stenting (100 bare metal, 61 drug-eluting) after being excluded from surgery. In group A, disease was confined to the ostium or main stem; in group B, disease involved the bifurcation. Patients were classified as either unprotected (U) or protected (P) depending on the presence of a patent bypass graft. Study endpoints were any major adverse cardiac event (MACE). In-hospital MACE was 6% with no deaths; 74% of patients in group A underwent direct stenting, whereas 89% of the patients in group B had predilatation performed prior to stent implantation. A total of 98% of patients in BU had kissing balloon inflations after stent deployment; provisional side-branch stenting was required in one patient. V-stenting was performed in 13% of patients in group BU. The 1-year mortality in the bare metal stent group was 9% with the majority of deaths in group BU. There was one noncardiac death in the DES group at 6 months and five patients (8.2%) underwent target vessel revascularization for restenosis. Event-free survival at 6 months in group BU treated with DESs was 87%. Significant left main disease presents a spectrum of angiographic abnormalities and different interventional techniques are required depending on lesion location and distal protection. Although in-hospital complications with left main stenting were low in this single-center study, follow-up events were common in patients treated with bare metal stents. A randomized multicenter trial will be required to determine whether drug-eluting stents will improve survival in patients with left main disease.

Aged↗
PubMed1995

Normal left main coronary artery diameter can be predicted from diameters of its branch vessels.

An uncommon though vexing problem exists when the left main coronary artery appears subjectively to be diffusely stenotic relative to its branch vessels, but the severity of such stenosis cannot be determined because of the lack of a normal reference. To overcome this problem, 20 coronary angiograms demonstrating no evidence of disease were quantitatively analyzed to determine the normal ratio of left main diameter to the sum of the diameters of its immediate branches. For bifurcating left mains, the mean ratio of diameter of left main to sum of diameters of its two immediate branches was 0.65 +/- 0.04; for trifurcating left mains, the mean ratio of diameter of left main to sum of diameters of its three immediate branches was 0.56 +/- 0.02. Thus, it appears feasible and practical to predict the normal diameter of the left main from the measured diameters of its immediate branches.

Arteries↗
PubMed2005

Correlation between histological effects on the main tumors and nodal status after chemoradiotherapy for squamous cell carcinoma of the esophagus.

BACKGROUND AND OBJECTIVES: Although the histological effectiveness of preoperative chemoradiotherapy against the main tumor is reported to be the strongest prognostic factor for patients with esophageal cancer, it remains unknown whether such chemoradiotherapy is equally effective against metastatic lymph nodes. METHODS: We studied 103 consecutive patients with esophageal cancer, who were given preoperative chemoradiotherapy followed by surgery. The histological effectiveness against the main tumor of the chemoradiotherapy was correlated with lymph mode metastasis and other clinico-pathological factors. RESULTS: The histological effectiveness against the main tumor was grade 3 in 26 patients, grade 2 in 49 and grade 1 in 28. The number of pathological node-negative patients was 21 (80.8%), 19 (38.8%), and 7 (25.0%) in those having grade 3, 2, and 1 responses of their main tumors, respectively. The average number of pathological metastatic lymph nodes was 0.19, 1.4, and 4.4 in patients with grade 3, 2, and 1 responses, respectively. Endoscopic biopsy after the chemoradiotherapy could not accurately diagnose the pathological complete response (CR) of the main tumors, with a high false negative rate (60.9%). CONCLUSIONS: The effects of chemoradiotherapy against main tumors significantly correlated with nodal status. Most patients with main tumors of pathological CR are node-negative. Patients with a grade 2 response have at most a few positive nodes. Surgery would be most beneficial for such patients.

Adult↗
PubMed1998

[Prognosis and management in patients with left main shock syndrome--emergency PTCA following CABG].

To clarify the optimal management and delineate the characteristics of patients with severe left main disease and cardiogenic shock as a result of an acute anterolateral myocardial infarction (left main shock syndrome), we analyzed the course of 13 such patients from September 1989 to June 1997. Of the 13 patients, 7 (53.8%) were managed with emergency coronary angioplasty (group A), 3 (23.1%) were treated with emergency coronary angioplsty following coronary bypass graft surgery (group B) and 3 (23.1%) underwent emergency coronary bypass graft surgery alone (group C). The interval from the beginning of myocardial ischemia to revascularization was 266 +/- 303 min. The degree of diameter stenosis found in the left main coronary artery was 98.1 +/- 1.8%. Overall in-hospital mortality for the 13 patient with left main shock syndrome was 76.9% (group A: 7/7; group B: 1/3; group C: 2/3, NS) and operative mortality was 61.5% (group A: 6/7; group B: 0/3; group C: 2/3, p = 0.03). When all 13 patients were examined together, the presence of ventricular tachycardia (VT) x ventricular fibrillation (Vf) was found to be the most powerful univariate predictor of operative death (p = 0.03). This is, 7 (87.5%) of the 8 patients with VT x Vf at presentation died within 30 postoperative days, and only 1 (20%) of the 5 patients without VT x Vf died (p = 0.03). Age, percent stenosis of the left main or right coronary arteries, the interval from the beginning of myocardial ischemia to revascularization, intubation, systolic pressure, fractional shortning, pulmonary artery pressure, pulmonary capillary wedge pressure, coronary risk factors, pulmonary edema, mitral regurgitation and percutaneous cardiopulmonary support failed to attain univariate significance at the P = .1 level. The postoperative peak CPK level was 15665 +/- 6710 IU/1 in operative death compared to 4733 +/- 2749 IU/1 in operative survival (p = 0.01). In conclusion, emergency coronary angioplasty following coronary bypass graft surgery for left main shock syndrome has been a very successful therapeutic option. Finally, for the entire group of 13 patients with left main shock syndrome, VT x Vf significantly decreased short-term survival.

Adult↗
PubMed1999

[Elective stenting of "unprotected" left main coronary stenosis in patients without contraindication to bypass surgery].

Coronary surgery is at this point of time the standard therapy of unprotected left main coronary artery stenosis. Coronary angioplasty (PTCA) is performed only in bail out situations. The number of publications of successful percutaneous intervention in unprotected left main coronary stenosis is increasing because of increasing use of stents and ticlopidine to avoid stent-thrombosis. From 9/96 to 7/98, 13 patients with unprotected left main coronary stenosis were treated with stents. All of them were accepted by the heart surgeon for bypass surgery but were not considered to be optimal candidates due to advanced age of more than 80 years (n = 5), significant co-morbidity (n = 2) or diffuse diseased peripheral coronary segments (n = 6). Mean age of patients was 74 +/- 10 years, 9 were male, and all patients presented with angina III-IV (CCS). Mean ejection fraction was 55 +/- 15%. Localization of stenoses were classified as ostial (n = 5), middle (n = 3), and bifurcational (n = 6). One patient had stenoses both in the ostium and in the bifurcation. In all cases a PTCA of the culprit stenosis was performed prior to stent implantation. The mean diameter of the stents used was 3.3 +/- 0.3 mm and the mean length was 11 +/- 4 mm. In 6 patients a PTCA of either left anterior descendens (LAD) or right coronary artery was performed in the same session. In 4 of these patients it was followed by a stent implantation. All procedures were performed with surgical stand-by, an intraaortal balloon pump was available, but was not uses prophylactically. Stent implantation could be performed successfully in 12 out of the 13 patients (success rate 92%). In bifurcational stenoses stents were positioned with the proximal end in the left main and the distal end in the LAD. Significant injury or occlusion of the circumflex artery was not observed. In one patient with bifurcational stenosis with severe calcification it was not possible to cross the lesion with an accurate sized balloon. Trying to cross with a smaller balloon (2.5 mm) resulted in dissection of the left main coronary artery which could not be reopened again by catheter technique. This patient was transferred to the operating room under conditions of cardiopulmonary resuscitation and a bypass surgery was performed. He was dismissed from the hospital with no evidence of perioperative myocardial infarction. The mean time for follow-up was 12 +/- 7 months, all patients are still alive. In 6 patients an angiography was performed during follow-up because of suspicion of recurrent ischemia. Two patients out of these 6 had restenoses in the left main coronary artery which were re-dilated (17%). Another 2 patients had stenoses in other coronary segments and were also dilated. Thus, stenting of left main coronary artery stenoses is feasible, however, with acceptable risks and could be considered in selected patients as an alternative to coronary artery surgery.

Aged↗
PubMed1975

Left main coronary artery disease. Risks of angiography, importance of coexisting disease of other coronary arteries and effects of revascularization.

To elucidate the determinants of the poor prognosis of patients with left main coronary artery disease and to assess the efficacy of diagnostic and therapeutic interventions the angiographic features and clinical course of 58 patients with left main coronary artery disease studied between September 1967 and June 1974 were analyzed. Eighty-three coronary arteriograms were obtained in these 58 patients using the Judkins technique; there were no immediate complications although one patient died 3 days after study. Previously cited predictors of left main coronary artery, unstable or nonexertional angina and marked S-T segment depression with exercise were found in a minority of patients; thus, the presence of the disease could not reliably be predicted before arteriographic study. Coexisting disease was found in either two or three other coronary arteries in 46 of 58 patients; only 2 patients had isolated left main coronary artery disease. Because the criteria for operability have changed in recent years, current criteria without knowledge of the treatment actually given or its outcome. The condition of 10 of 58 patients was judged inoperable in retrospect because of severe coexisting distal coronary artery disease (8 patients) or ventricular dysfunction (2 patients). Of 19 patients whose condition was judged operable in retrospect but who were treated without surgery, 9 died, 8 within 18 months; 10 have survived 12 to 83 months. Another 27 patients with a condition judged operable in retrospect had received saphenous vein bypass grafts. In this group, there were four operative and three late deaths. The severity of angina decreased in survivors treated surgically but was unchanged in survivors treated without surgery. The improvement in survival rates of surgically treated patients was not statistically significant. The data indicate that coronary arteriography can be performed at low risk with the Judkins technique even though preangiographic prediction of left main coronary artery disease is unreliable. Coexisting disease in oter major coronary arteries is an important determinant of the poor prognosis of patients with left main coronary artery disease and precludes surgery in 13 percent. Isolated left main coronary artery disease is uncommon. Surgical therapy relieves symptoms more effectively than nonsurgical therapy.

Angina Pectoris↗