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1、Lu Shuzheng M.D. FAPSIC. Beijing Anzhen Hospital Capital Medical University,Left Main Disease:,Evidence-base Medicine & Realistic World,Anatomy importance of LM,Compromises flow to approximately 75% of the left ventricle; Acute occlusion of ULMCA will cause MI ,cardiac shock or acute heart failure,
2、cardiac arrest(50%70%).,Anatomy features of LMCA Disease,Most elastic tissue; Higher elastic radial force.,Classification based on location of lesions,Ostium Shaft/Body Distal,Clinical Results of DES for ULMCA,DES for the ULMCA,*Follow-up angiography at 6 moths. Fellow-up angiography at 4 to 8 month
3、s. Fellow-up angiography at 3 and 9 months. Target lessin revascularization. Target vessel revascularization (TVR). Date from Baim et al. DES drug eluting stent; NR not reported.,(3.7-7.7),Recent Meta-Analysis of 1,278 Patients Undergoing UPLM DES From 15 Registries Date from Biondi-Zoccai et al,DES
4、 for the ULMCA,(3.4-7.7),Recent Meta-Analysis of 1,278 Patients Undergoing UPLM DES From 15 Registries Date from Biondi-Zoccai et al,DES for the ULMCA,(3.7-9.2),PCI vs. CABG Bologna Registry,PCI vs. CABG Milan experience,PCI vs. CABG Cedars Sinai Registry,LE MANS Study design,Number of patients scre
5、ened with ULMCA Disease: 347,Patients eligible for study: 122,Patients noneligible for study included in LE MANS Registry: 225,Randomized patients: 105,Nonrandomized patients: 17,PCI 102,CABG 123,PCI 52,CABG 53,PCI 9,CABG 8,All patients treated according to randomization (no crossover),First RCT stu
6、dy of ULMCA,LE MANS Study baseline,LE MANS Study LVEF at baseline and after 12 months,p=0.22,p=0.04,p=0.01,p=0.85,LE MANS Study CCS function class at baseline and follow-up,p=0.22,p=0.01,p=0.10,p=0.01,p=0.11,LE MANS Study treadmill stress tests at baseline and follow-up,p=0.03,p=0.31,p=0.97,p=0.53,L
7、E MANS Study,PCI,CABG,Survival after PCI and CABG,MACCE-Free Survival after PCI and CABG,PCI,CABG,More RCT Trial Needed,ULMCA in Realistic World,Left Main Strategies,Ostium Lesions,Shaft Lesions,Bifurcation Lesions,What do you think about this patient,Male, 73y; Exertional Chest Pain 3m, Aggravated
8、10d; Diag: CAD UAP Braunwald B; Other RF: HT, Smoking; Echo: EF 68%, LVEDD 50mm; To Cath Lab.,4 Bifurcation Lesions,Which one is the first; Technique of each lesion; V/T/Kissing stent for LM; How to do the final kissing.,Crossover,T Stent,T Stent,Crush,GC: 7F JL4; GW: Stablizer Supersoft, Runthrough
9、, Rinato, ATW; BC: Sprinter 2.5*15mm, Sprinter 1.5*15mm; SC: SES 3.0*24mm, SES 2.5*33mm,SC: SES 2.5*18mm, SES 3.5*18mm,GW: Pilot50; BC: Sequent 3.0*10mm SC: SES 4.0*15mm,Final Result,CABG vs. DES our experiences,Lesions Distribution,From 2004 to 2006, 393 pts with LM lesions, FU 4y, Registry Study,255 pts in CABG Group & 138 pts in DES Group,Different Techniques of Bifurcation Lesions,CABG vs. DES our experiences,p0.05,Prognosis -FU 4y,From 2004 to 2006, 393 pts with LM lesions, FU 4y, Registry Study,255 pts in CABG Group & 138 pts in DES Group,Survival -FU 4y,p0.05,80%,Thanks,
