Drug-Eluting Stents Effective for Percutaneous Coronary Intervention

Complications associated with left main bifurcation can impact stent choice.

Percutaneous coronary intervention (PCI) for left main coronary stenosis using second-generation drug-eluting stents (DES) may be a safe method for most patients, according to a study presented at the American College of Cardiology 2017 scientific session.

The investigators also reported that outcomes using DES are similar to those with coronary artery bypass grafting; however, the findings present problems with target lesion revascularization (TLR).

PCI has been established as a safe and effective alternative to CABG in patients whose SYNTAX score is low or intermediate, which is how the severity of coronary artery disease is quantified. This has been confirmed by numerous other studies.

The current study was designed to provide insight about patient selection, risk scoring, intracoronary imaging, vessel preparation, and selection of stenting technique, according to the authors.

They found that a single-stent provision approach was preferred.

Left main bifurcation is present in more than 80% of left main stenoses, and potential complications to left circumflex and TLR could impact choices between stent technique, according to the study.

Left main bifurcation can be a challenge because it requires larger stents, an understanding of the stent platform to expand, and recognizing diffuse left main disease, the authors noted.

The authors recommend a heart team approach for elective PCI at facilities that have intravascular ultrasound or optical coherence to ensure optimal outcomes. These facilities should also be able to evaluate coronary physiology and have access to atherectomy and circulatory support.

Conducting a pre-PCI assessment and planning techniques are crucial to success. Using the Medina angiographic classification of the bifurcation lesion, as well as an imaging and functional assessment, are necessary for a successful PCI, according to the study.

The authors also developed an algorithm for the management of left main bifurcation. They outlined potential treatment options for patients that incorporates guideline recommendations. Hemodynamic support for high-risk PCI, lesion classification, and stenting techniques for both simple and complex lesions were discussed, according to the study.

"Neither of the two trials studied outcomes beyond 5 years," said Kim A. Eagle, MD, MACC, editor-in-chief of ACC.org. "Therefore, further studies are needed to assess the long-term durability of each approach."