Recent experience with percutaneous recanalization of "protected" left main using new angioplasty devices

The results of percutaneous recanalization of "protected" left main coronary arteries are described in 32 patients with recurrent angina after coronary artery bypass surgery. Thirty-seven procedures were attempted using various combinations of new devices (rotational ablation, directional atherectomy and stents). Most patients (21) were treated < 2 years after surgery and in 20 patients the disease in the left main progressed compared to the preoperative angiogram. In 10 patients (31%) an intra-aortic balloon pump was inserted prior to, or during the procedure due to high-risk anatomy and/or hemodynamic instability. The procedure was successful in 30 of the 32 patients (94%). There were no major complications (death, Q-wave myocardial infarction or emergency coronary artery bypass surgery). Rotational ablation was attempted in 21 patients (succeeded in 19). Coronary stents were implanted initially in 18 patients. Target left main revascularization was required in 5 patients (4 without a stent who underwent stent implantation, and 1 with a stent who underwent balloon angioplasty to in-stent restenosis). We conclude that selected patients with protected left main can be treated with percutaneous revascularization. Even though this can be a high-risk procedure, successful outcome can be achieved using a strategy that combines rotational ablation and coronary stenting.