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 LMT
Club |
| Dr. Takahiko Suzuki, Dr. Yasushi
Asakura |
In the LMT club of CCT 2004,
national and international specialists discussed
about treatment strategies for the left main trunk
stenosis in DES era.
Dr. Suzuki first emphasized the importance of LMT-PCI
in the era of DES and how this therapy affects patients
with complex lesions.
After Dr. Cheavalier from Center Cardiologique du
Nord, Dr. Ehara from Toyohashi, Dr. Park from Asan
Medical Center, Dr. Santoso from Medistra Hospital,
and Dr. Tsuchikane from Toyohashi presented their
lectures about the LMT disease in DES era, a discussion
was begun.
“Introduction of the DES certainly provides
acceptable outcomes on the orifice and shaft of
the LMT. Could we routinely use the DES in these
two segments of LMT stenosis?” Dr. Suzuki
asked to Dr. Park. “Based upon our current
study, results were acceptable in terms of restenosis
and TLR. Thus, we can routinely perform a PCI in
the orfice and shaft of LMT stenosis,” said
Dr. Park.
“For a bifurcation lesion, either single or
crossover stenting demonstrated favorable outcomes.
However, the Y or T stent is often required to perform
in certain cases. Results vary depend upon technique.
What criteria should we use to perform certain technique?
Dr. Suzuki asked speakers.
Dr. Park said that the selection of technique depends
upon a vessel diameter in LMT stenosis. “
If it exceeds 4mm and stenosis locates at the orifice
if LCx, I perform kissing stent. In contrast, crossover
stenting technique is used if it is less than 4mm
and no stenosis at LCx is observed. The crush or
modified T technique is also considered if stenosis
is located at LCx, “ Dr. Park added.
A next question is the role of debulking in DES
era. Dr. Suzuki asked the efficacy of thedebulking
strategy and its impact on complex stenting technique.
He also asked the meaning of deulking in the era
of DES.
“Debulking has a meaning for the LMT stenosis
in DES era, especiall a lesion with larger plaque
burden. Debulking will prevent the risk of plaque
shift,” said Dr. Santoso.
Plaque burden. Debulking will prevent the risk of
plaque shift,” said Dr. Santoso.
Dr. Suzuki said that the penetration rate of DCA
had declined in the DES era. “ A lower MLD
may mean higher restenosis. Though the absolute
rate of restenosis is declined in DES era, lower
MLD and longer stent implantation are independent
predictors of restenosks.
Thus, DCA is still the important strategy to obtain
a higher MLD.” Said Dr. Park.
Finally, Dr. Asakura asked all speakers regarding
the effect of CABG for the LMT. “ I did not
consider CABG for LMT stenosis even in the BMS era.
If DCA is properly performed, I prefer stenting
in the LMT even in the era of BMS. The RLR should
be targeted at zero if DES is used. We should collect
as much data as possible in this segment."
Said Dr. Tsuchikane. Dr. Santoso recommended a bypass
surgery if a patient experienced the LMT stenosis.
For this question, Dr. Park said," a treatment
stategy very depends upon a patient. If a DM patient
experiences poor LV function, CABG is a first treatment
option for this patient.”
" We should have enough evidences to choose
an appropriate treatment strategy for the LMT stenosis
in DES era," said Dr. Asakura and closed the
session. |
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