DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20171848

Clinical outcome of proximal left anterior descending revascularization with everolimus eluting stents via transradial route: a single centre experience in Western Rajasthan, India

Rohit Mathur, Goutam Kumar, Deepak Gupta, Sanjeev Sanghvi, Anil Baroopal

Abstract


Background: The proximal left anterior descending (LAD) artery stenosis represents the most important proximal site for obstructive coronary artery, as it supplies 40%–50% of the total left ventricular myocardium and could result in ischemia to a large area of myocardium. This study assesses the clinical outcome of patients with coronary artery diseases undergoing percutaneous revascularization with everolimus eluting stent implantation in the proximal left anterior descending coronary artery via trans radial route.

Methods: 150 patients with significant angiographic lesion of proximal LAD artery stenosis treated with PTCA and stenting to proximal LAD via TRA were selected for study and were followed for one year.

Results: Total 15 events were recorded 4 (2.6%) deaths and 11 (7%) MI and TLR was noted in 4% of patients. One (0.6%) case of acute stent thrombosis was recorded.

Conclusions: Total MACE of this record (10% at 12 months of clinical follow-up) is consistent with those observed in the large randomized and multi-center studies with drug-eluting stents implanted in the proximal left anterior descending artery.


Keywords


Everolimus eluting stent, Left anterior descending artery, Trans radial route

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References


Cisowski M, Gerber A, Ulczok R, Samra R, Drzewiecki J, Guzy M, et al. Primary direct stenting versus endoscopic atraumatic coronary artery bypass surgery in patients with proximal stenosis of the left anterior descending coronary artery - a prospective, randomised study. Kardiol Pol. 2004;61:253-61.

Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn. 1989;16:3-7.

Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary stent implantation. Cathet Cardiovasc Diagn. 1993;30:173-8.

Bertrand OF, Bélisle P, Joyal D, Costerousse O, Rao SV, Jolly SS, et al. Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J. 2012;163:632-48.

Carlo M, Borelli G, Gistri R, Ciabatti N, Mazzoni A, Arena M, et al. Effectiveness of the transradial approach to reduce bleedings in patients undergoing urgent coronary angioplasty with GPIIb/IIIa inhibitors for acute coronary syndromes. Catheter Cardiovasc Interv. 2009;74:408-15.

Hamon M, Rasmussen LH, Manoukian SV, Cequier A, Lincoff MA, Rupprecht HJ, et al. Choice of arterial access site and outcomes in patients with acute coronary syndromes managed with an early invasive strategy: the ACUITY trial. Euro Intervention. 2009;5:115-20.

Valsecchi O, Musumeci G, Vassileva A, Tespili M, Guagliumi G, Gavazzi A, et al. Safety, feasibility and efficacy of transradial primary angioplasty in patients with acute myocardial infarction. Ital Heart J. 2003;4:329-34.

Jolly SS, Yusuf S, Cairns J, Niemella K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377:1409-20.

Généreux P, Mehran R, Palmerini T, Caixeta A, Kirtane AJ, Lansky AJ, et al. Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction: the HORIZONS-AMI trial. Euro Intervention. 2011;7:905-16.

Stone GW, Rizvi A, Newman W, Mastali K, Wang JC, Caputo R, et al. Everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease. N Engl J Med. 2010;362:1663-74.

Kedhi E, Joesoef KS, Fadden E, Wassing J, Mieghem CV, Goedhart D, et al. Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice (COMPARE): a randomised trial. Lancet. 2010;375:201-9.

Klein LW, Weintraub WS, Agarwal JB, Schneider RM, Seelaus PA, Katz RI, et al. Prognostic significance of severe narrowing of the proximal portion of the left anterior descending coronary artery. Am J Cardiol. 1986;58:42-6.

Joner M, Nakazawa G, Finn AV, Quee SC, Colem L, Acampado E, et al. Endothelial cell recovery between comparator polymer-based drug-eluting stents. J Am Coll Cardiol. 2008;52:333-42.

Palmerini T, Zoccai G, Riva DD, Stettler C, Sangiorgi D, Ascenzo F, et al. Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. Lancet. 2012;379:1393-402.

Baber U, Mehran R, Sharma SK, Brar S, Yu J, Suh JW, et al. Impact of the everolimus-eluting stent on stent thrombosis: a meta-analysis of 13 randomized trials. J Am Coll Cardiol. 2011;58:1569-77.