Real-world five-year outcomes of FlexyRap®cobalt-chromium rapamycin-eluting stents with biodegradable polymer in patients with de-novo coronary artery disease

BACKGROUND The use of biodegradable polymer drug-eluting stents(BP-DES)has been proven to minimize restenosis and stent thrombosis.The current post-marketing monitoring was observed at the 5-year clinical outcomes of individuals who had been treated with FlexyRap®DES in the real world.AIM To assess the safety and effectiveness of FlexyRap®DES at the 5-year follow-up in real-world settings.METHODS Findings from a retrospective,multi-center,observational,post-market clinical follow-up study of patients treated with FlexyRap®DES for de novo coronary artery disease(CAD)were reported.During the 12-mo follow-up,the primary endpoint was target lesion failure,which was defined as the composite of cardiovascular death, target vessel myocardial infarction(TV-MI), and clinically driven target lesion revascularization.RESULTS The data of 500 patients received with FlexyRap®DES was obtained at the completion of the surveillance timeline of 5-year.After the implantation of FlexyRap®DES,the device success rate was 100%.Adverse events that led to major bleeding,permanent disability,or death were not experienced in the patients.The major adverse cardiac event rate at 12-mo,3-year,and 5-year follow-up was 1(0.2%),0(0%),and 1(0.2%)respectively with 0(0%)cardiovascular death,2(0.4%)TV-MI,and 0(0%)TLR compositely.Furthermore,late stent thrombosis was found in 2(0.4%)patients at the follow-up of 12-mo,very late stent thrombosis was observed in 2 patients(0.4%)at 3-year follow-up.CONCLUSION FlexyRap®DES was proved to be safe and efficacious in real-world patients with de novo CAD,indicating a lowered rate of cardiac events and stent thrombosis at 5-year follow-up.

Reduction in the Corrosion Rate of Magnesium and Magnesium Alloy Specimens and Implications for Plain Fully Bioresorbable Coronary Artery Stents: A Review

The most popular treatment/management modality for coronary artery disease, which is one of the leading causes of death, is percutaneous transluminal coronary intervention (popularly known as “plain old balloon angioplasty”) followed by implantation of a stent (“stenting”). Stent types have evolved from bare metal stents through first-generation drug-eluting stents to fully bioresorbable stents (FBRSs). Two examples of FBRSs are 1) Mg scaffold with no coating;and 2) Mg alloy scaffold coated with a bioresorbable polymer in which an anti-proliferative drug is embedded. In the case of Mg/Mg alloy FBRSs, one of the reported clinical results is that the resorption time of the stent is too short (in vivo resorption time (and, hence, improving the clinical efficacy) of the current generation of fully-bioresorbable Mg/Mg-alloy stents as well as guide the development of the next generation of these stents.

Role of Second-Generation Drug-Eluting Stents and Bypass Grafting in Coronary Artery Disease:A Systematic Review and Meta-analysis

Background:The safety and efficacy of coronary artery bypass grafting(CABG)and second-generation drug-eluting stents(DESs)in patients with coronary artery disease(CAD)remain controversial.Therefore we aimed to compare the outcomes of CAD patients treated with CABG and second-generation DESs.Methods:We systematically searched the PubMed,Cochrane Library,Ovid,and Elsevier databases.Studies comparing second-generation DESs with CABG in CAD patients were included.RevMan 5.3 was used to extract and pool the data from the applicable studies.Results:Six trials(N=6604 participants)were included in this meta-analysis.Among all of the CAD patients,second-generation DESs were associated with no differences in the risks of all-cause death[risk ratio(RR)1.18,95% confi dence interval(CI)0.98–1.43,P=0.09],cardiovascular death(RR 1.14,95% CI 0.81–1.59,P=0.45),myocardial infarction(RR 1.22,95% CI 0.98–1.54,P=0.08),and stroke(RR 0.83,95% CI 0.59–1.17,P=0.29),but increased the risks of revascularization(RR 1.95,95% CI 1.66–2.30,P<0.001)and major adverse cardiac and cerebrovascular events(RR 1.72,95% CI:1.31–2.26,P<0.001)when compared with CABG.Conclusions:In the treatment of CAD patients,second-generation DESs was not associated with increased risks of all-cause death,cardiovascular death,myocardial infarction,and stroke,but increased the risks of revascularization and major adverse cardiac and cerebrovascular events when compared with CABG.

Evaluation of Clinical Outcomes of ses Stent in Patients with Coronary Artery Disease After Intracoronary Stenting in Small Vessels

Background:Limited data are available for sirolimus-eluting stent(SES,Cypher)implantation in patients with coronary artery disease in small vessels.The clinical longtermoutcomes of SES in patients with coronary artery disease after intracoronary stenting in small vessels has not been yet evaluated.

Six-month results of a biodegradable polymer and rapamycin-coating stent for coronary artery disease

Objective To assess the safety and efficacy of a novel biodegradable polymer and rapamycin-coating stent, the EXCEL stent, in the treatment of coronary artery disease (CAD), as compared with the CypherTM stent. Methods In this prospective, non-randomized study, 60 consecutive patients with symptomatic CAD received either an EXCEL stent (n=32), or a CypherTM stent(n=28),according to their respective treatment intention. Follow-up angiography was performed at a mean of 180±40 days. The primary endpoint of the study was the occurrence of a major adverse cardiac event (MACE), including death, myocardial infarction, or target-vessel revascularization during the 6 months after stenting. The secondary end points included the in-stent late luminal loss (LLL), percentage of in-stent stenosis of the luminal diameter, and the rate of restenosis (luminal narrowing of 50 percent or more) at 6 months. Results There were no significant differences between the two groups in baseline characteristics, including the distribution of target vessel and lesion types. During the follow up period of 6 months, there were no occurrences of MACE in either group. Twenty-seven patients(84%) in the EXCEL group and 10 (36 %) in the CypherTM group underwent quantitative coronary angiography at 6 months. For these patients, no restenosis occurred, and there were no differences in the in-stent stenosis of the luminal diameter (5.98±5.52% vs 5.21 ±6.3%,P＞0.05) and the LLL (-0.02±0.09 mm vs -0.01±0.07 mm, P＞0.05). Conclusions Compared with the CypherTM stent, the EXCEL Stent with biodegradable polymer and rapamycin-coating showed similar efficacy in the prevention of neointimal proliferation, restenosis, and associated clinical events in CAD patients.

Assessment of Coronary Stents by 64-slice Computed Tomography: In-stent Lumen Visibility and Patency

Objective To assess lumen visibility of coronary stents by 64-slice computed tomography (CT) coronary angiography, and determine the value of 64-slice CT in non-invasive detecting of in-stent restenosis after coronary artery stent implantation. Methods Totally, 60 patients (54 males, aged 57.0±12.7 years) and 105 stents were investigated by 64-slice CT at a mean interval of 20.0±16.6 months after coronary stents implantation. Axial multi-planar reconstruction images of the stents and curved-planar reconstruction images through the median of the stents were reconstructed for evaluating stent image quality on a 5-point scale (1=excellent, 5=non assessable), and stent lumen diameter was detected. Conventional coronary angiography was performed in 18 patients, and 32 stents were evaluated. Results Image quality was good to excellent on average (score 1.71±0.76). Stent image quality score was correlated to heart rate (r=0.281, P<0.01) and stent diameter (r=-0.480, P<0.001). All the stents were assessable in lumen visibility with an average visible lumen diameter percentage of 60.7%±13.6%. Visible lumen diameter percentage was correlated to heart rate (r=-0.193, P<0.05), stent diameter (r=0.403, P<0.001), and stent image quality score (r=-0.500, P<0.001). Visible lumen diameter percentage also varied depending on the stent type. In comparison with the conventional coronary angiography, 4 of 6 in-stent stenoses were correctly detected. The sensitivity and specificity for the detection of in-stent stenosis were 66.7% and 84.6%, respectively. Conclusions Using a 64-slice CT, the stent lumen is partly visible in most of the stents. And 64-slice CT may be useful in the assessment of stent patency.

Genetics of coronary artery disease and myocardial infarction

Atherosclerotic coronary artery disease(CAD) comprises a broad spectrum of clinical entities that include asymptomatic subclinical atherosclerosis and its clinical complications, such as angina pectoris, myocardial infarction(MI) and sudden cardiac death. CAD continues to be the leading cause of death in industrialized society. The long-recognized familial clustering of CAD suggests that genetics plays a central role in its development, with the heritability of CAD and MI estimated at approximately 50% to 60%. Understanding the genetic architecture of CAD and MI has proven to be difficult and costly due to the heterogeneity of clinical CAD and the underlying multi-decade complex pathophysiological processes that involve both genetic and environmental interactions. This review describes the clinical heterogeneity of CAD and MI to clarify the disease spectrum in genetic studies, provides a brief overview of the historical understanding and estimation of the heritability of CAD and MI, recounts major gene discoveries of potential causal mutations in familial CAD and MI, summarizes CAD and MIassociated genetic variants identified using candidate gene approaches and genome-wide association studies(GWAS), and summarizes the current status of the construction and validations of genetic risk scores for lifetime risk prediction and guidance for preventive strategies. Potential protective genetic factors against the development of CAD and MI are also discussed. Finally, GWAS have identified multiple genetic factors associated with an increased risk of in-stent restenosis following stent placement for obstructive CAD. This review will also address genetic factors associated with in-stent restenosis, which may ultimately guide clinical decision-making regarding revascularization strategies for patients with CAD and MI.

Long-term effect of stenting in unprotected left main coronary artery disease in the elderly

To evaluate the feasibility, safety and efficacy of percutaneous stent implantation for treating left main coronary artery (LMCA) stenosis. Methods Consecutive patients with unprotected left main coronary artery disease treated by stent-based percutaneous intervention (PCI) at 6 medical centers in China were enrolled. Procedural data and clinical outcomes were obtained from all patients. Results From January 2001 to December 2004, 138 patients (79 males and 59 females; mean age: 69.7±5.8 years)underwent PCI for LMCA stenosis. Bare metal stents (BMS) were implanted in 51 patients with non-bifurcational lesions and in 5 patients with bifurcational lesions from January of 2001 to June of 2003 (BMS group);. Drug eluting stents (DES) were used unselectively to cover both bifurcational and non-bifurcational lesions in 86 patients from July of 2003 to December of 2004 (DES group). Procedural success rate of the 138 cases was 98% (135/138). One patient (0.7%) with bifurcation lesion who was treated with DES died from severe heart failure 2 weeks after the procedure. During a mean follow up period of 21.3 ± 5.6 months, one patient died from renal failure, one from sudden cardiac death, 4 underwent target lesion revascularization (TLR) in the BMS group, which all occurred in patients with bifurcational lesions; whereas in the DES group no deaths occurred and only one patient with bifurcational lesion had TLR. Conclusions (1) PCI is feasible and relatively safe to treat unprotected left main coronary artery disease in elderly patients at medical centers with experienced professionals. (2) BMS and DES have similar immediate and long-term efficacy in the treatment of ostium and shaft lesions of the LMCA. (3) DES are strongly suggested in the therapy of distal bifurcation lesion of unprotected LMCA.

Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease

The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents(DES) vs bare metal stent(BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years(60% of success) when compared to BMS(58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs(P < 0.05) per success for the BMS strategy(15520 €/success), as compared to the DES strategy(15588 €/success). Incremental costeffectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.

Life-threatening subclavian artery bleeding following percutaneous coronary intervention with stent implantation:A case report and review of literature

BACKGROUND Vascular complications of transradial percutaneous coronary intervention(PCI)are rare and usually occur at the access site below the elbow.Life-threatening vascular complications during transradial PCI therapy,such as vessel perforation and dissection in the brachiocephalic,subclavian,internal mammary,and thyrocervical arteries,are rarely reported.Subclavian artery bleeding is a potentially serious complication of vascular interventional procedures leading to tracheal obstruction,hemothorax,respiratory failure,hemorrhagic shock,and death if not diagnosed early and treated promptly.CASE SUMMARY A male patient with typical angina pectoris underwent coronary angiography and stent implantation.During the procedure,the patient felt pharyngeal pain and tightness,which we mistook for myocardial ischemia.After PCI,swelling in the right neck and supraclavicular area was observed.The patient experienced dyspnea,emergency endotracheal intubation was performed,and then a sudden drop in blood pressure was observed.Ultrasound and contrast-enhanced computed tomography scans demonstrated a cervical hematoma severely compressing the trachea due to subclavian artery bleeding.Brachiocephalic angiography revealed a vascular injury site at the root of the right subclavian artery at the intersection of the right common carotid artery.A covered stent was deployed to the right subclavian artery with successful sealing of the perforation,and a bare stent was implanted in the junction of the right common carotid and brachiocephalic arteries to prevent obstruction of blood flow to the brain.CONCLUSION Subclavian artery bleeding is a lifethreatening complication of PCI.Early prevention,rapid recognition,and prompt treatment may improve the prognosis.

Long term outcomes of drug-eluting stent versus coronary artery bypass grafting for left main coronary artery disease： a meta-analysis

BackgroundIt 仍然是争论的有 drug-eluting stent ( DES )的经皮的冠的干预是否与冠的动脉相比安全、有效为没有防卫的左主要冠的动脉( ULMCA )绕过接枝外科( CABG )疾病在长期列在后面在上面( 3 年) .MethodsEligible 研究被寻找 PubMed 选择， EMBASE ，并且 Cochrane 图书馆直到2016年12月6日。主要端点是一死亡，心肌的梗塞(MI ) 或在最长的后续期间的击合成。死亡，心脏的死亡， MI，击和重复 revascularization 是第二等的 outcomes.ResultsFour 使随机化的控制试用和包含 14,130 个病人的 12 调整观察研究被包括。DES 比得上关于主要端点的出现的 CABG (HR = 0.94， 95% CI：0.86-1.03 ) 。而且， DES 显著地与 MI 的更高的发生被联系(HR = 1.56， 95% CI：1.09-2.22 ) 并且重复 revascularization (HR = 3.09， 95% CI：2.33-4.10 ) 当没有差别在二策略之间被发现时，与 CABG 相比认为是死亡，心脏的死亡和击的率。而且， DES 能减少死亡， MI 或击的合成端点的风险(HR = 0.80， 95% CI：0.67-0.95 ) 因为有句法的 ULMCA 损害与重复 revascularization 的更高的风险获得 32 .ConclusionsAlthough，有 DES 的一种总线标准看起来象为 ULMCA 疾病在的 CABG 一样安全长期列在后面起来。另外，有 DES 的治疗能是到为 ULMCA 损害与的 CABG 的其他的 interventional 策略对中间的解剖复杂性低。

Nine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large coronary vessel lesions

sTo 与大冠的 vessels.MethodsFrom 2004年4月为病人与赤裸金属的 stents ( BMS )相比评估 drug-eluting stents ( DES )的长期的安全和有效性到2006年10月， 2407 个连续病人经历 de novo 损害有比大或等于在在中国北京的 Fu Wai 医院的 3.5 公里的参考容器直径的经皮的冠的干预，有希望地被注册进这研究。我们包括死亡，心肌的梗塞(MI ) ，血栓，目标损害 revascularization (TLR ) ，目标容器 revascularization (TVR ) ，和主要不利心脏的事件获得了 9 年的临床的结果(向，死亡， MI，和 TVR 合成) 。我们执行了艇长比例危险的模型在倾向 match.ResultsAfter 倾向得分以后估计所有结果措施的相对风险， 514 个对待 DES 的病人被匹配到 514 个对待 BMS 的病人。与 BMS 对待的病人与 TLR 的更高的风险被联系(HR：2.55， 95%CI：1.520-4.277， P = 0.0004 ) 并且 TVR (HR：1.889， 95%CI：1.185-3.011， P = 0.0075 ) ，但是 death/MI 和向的率不是统计上不同的。所有学术研究协会定义 stent 血栓在 9 年在二 groups.ConclusionsDuring 是可比较的整个九年的长期的后续，在有大冠的动脉的病人的 DES 的使用仍然在 TLR 和 TVR 的风险与重要减小被联系。

Therapeutic effect of interventional therapy for unprotected left main coronary artery lesions in aged patients

ObjectiveTo assesse 在有没有防卫的左主要冠的动脉( UPLM )的年老的病人的 interventional 治疗的治疗学的效果是超过 60 年并且在我们的医院里从2012年1月接受了 UPLM 的 interventional 治疗到2013年11月的 61 个病人全部的 lesions.MethodsA 被跟随在上面为由电话的一般水准 14.6 月或门诊病人访问。我们分析了 interventional 治疗的临床的特征数据并且估计了多半影响了 61 个病人的临床的 prognosis.ResultsThe 一般水准年龄的因素是 73.9 年。平均左室的喷射部分(LVEF ) 是 47.7% 。估计的 glomerular 过滤率(eGFR ) 中部每 1.73 公里 2 是 52 mL/min。平均句法分数是 27.4 并且 stent 中部长度是 36 公里。在在一年以后的 30 天和主要不利心脏的事件(向) 的心脏的死亡的累积发生是 6.6% 和 32.5% 分别地由 Kaplan-Meier 阴谋估计了。没有严重出血性的复杂并发症在后续时期期间被观察。在有比例的危险建模的艇长的 multivariate 回归分析上， LVEF 是在 30 天的心脏的死亡的一个独立预言者[危险比率(HR ) ：0.7， P = 0.01 ] 。至于在一年以后的向， LVEF 和 eGFR 两个都是独立预言者(HR：0.91， P = 0.06 为 LVEF， HR：0.03， P = 0.097 为 eGFR ) 为 UPLM 的 .ConclusionsThe interventional 治疗在年老的病人有效、安全。LVEF 是在 30 天的心脏的死亡的唯一的预言者，当 LVEF 和 eGFR 两个都是在一年以后的向的独立预言者时。

Solid Mechanical and Hemodynamic Analyses of Different Stent Structures in a Curved Stenotic Coronary Artery

Background Coronary artery stenting is commonly used for the treatment of coronary atherosclerosis,but it causes serious clinical complications,such as the in-stent restenosis(ISR).The main reason leading to ISR is the neointimal hyperplasia(NH),which is related to the stresses of plaque and artery,and to the altered local hemodynamic environment due to the presence of stents.Different stent structures indeed have various impacts on the stresses of plaque and artery,and the local hemodynamic environment,such as the wall shear stress(WSS),average WSS(AWSS),and WSS gradient(WSSG).Thus,it is important to evaluate the performance of stents with different structures by the mechanical factors after coronary stenting.Methods Six stents implanted into a stenotic curved coronary artery were treated separately,and they included three typical commercial stents(Palmaz-Schatz,Xience,and Cypher)and three author-developed stents,which were constructed by reducing the numbers of link(C-Rlink)and crown(C-Rcrown),and aligning the strut(C-Astrut)of the commercial Cypher Solid mechanical analyses of the balloon-stent-plaque-artery system in Abaqus were first performed to assess the performance of different stent structures and provide the deformed boundary of lumen for the subsequent hemodynamic analysis.With the deformed boundary,then hemodynamic analyses in Ansys were conducted to quanti-fy the hemodynamic parameters induced by different stent structures.Combining the solid mechanical and hemodynamic analyses,the performance of the six stents was evaluated.Results The results show that among the three commercial stents,the Palmaz-Schatz stent has the least stent dogboning and recoiling,which corresponds to the greatest maximum plastic strain as well as the largest diameter.However,it induces the greatest maximum stress of plaque,intima,and media.From the viewpoint of hemodynamics,the Palmaz-Schatz stent also performs better and it has smaller areas of adverse low WSS(<0.5 Pa),high WSS(>15 Pa),low AWSS(<0.5 Pa),and high WSSG(>5 000 Pa/m).Compared to the commercial Cypher stent,the author-developed Cypher-based C-Rcrown and C-Astrut stents have smaller recoiling,greater maximum plastic stain and larger diameter,which indicates the improved mechanical performance of the Cypher stent.Moreover,both C-Rcrown and C-Astrut have smaller areas of adverse low WSS,high WSS,and low AWSS,but only C-Rcrown has smaller area of adverse high WSSG.Nevertheless,the C-Rlink stent is inferior to the commercial Cypher stent.In both senses of the solid mechanical and local hemodynamic analyses,the C-Rcrown stent is superior to the commercial Cypher stent and other Cypher-based stents.Conclusions In this study,solid mechanical and hemodynamic analyses were carried out to study the effects of six stents with different structures on their performances after stenting.It was found that the Palmaz-Schatz stent performed better than other two commercial stents,and the performance of the Cypher stent could be improved by reducing the number of crowns of its strut.The present study comparatively evaluates the performance of different stents inside a curved artery,and could be used as a guide to select a suitable commercial stent for clinical application,and provide a way to improve the performance of the existing commercial stents.

Percutaneous revascularization in a patient with anomalous origin of left main coronary artery

Anomalous origin of the coronary artery from opposite coronary sinus is infrequently observed during coronary angiography. Percutaneous coronary intervention (PCI) of anomalous coronary artery is technically difficult and challenging. It requires appropriate selection of guide catheters for adequate stability, coaxial alignment and backup support during the intervention. We hereby report a rare case of anomalous origin of left main coronary artery (LM) from the right coronary sinus, having a retro-aortic course to the left side before its bifurcation into left anterior descending (LAD) and circumflex artery. The 59-year-old man had successful PCI of atherosclerotic LAD lesions. A 64-slice Multi-Detector Computed Tomography (MDCT) performed at 4 years of follow-up demonstrated patency of coronary stents and also delineated the origin and course of the anomalous LM. The case illustrates the rarity of anomalous LM, and describes technical issues during PCI and the role of MDCT in coronary anomaly imaging.

Coronary artery stents and surgery;the basis of sound perioperative management

The introduction of drug-eluting stents (DES) to interventional cardiology heralded a limited time of increased anaesthetic and surgical complications in patients implanted with these devices. The horns of the dilemma, in the anaesthetic and surgical management of patients in the first 3-6 months after the 1st generation DES insertion, were between the risk of bleeding from continued clopidogrel treatment and the risk of instent thrombosis and myocardial infarction following discontinuation of dual antiplatelet therapy, clopidogrel and aspirin. Initial accounts of early catastrophic cardiac and haemorrhagic complications, at the time of elective or emergency surgery, following DES insertion, were followed by equally worrying reports of instent thrombosis many months after DES insertion. Initial recommendations for the conduct of safe operations were propagated in the literature before formal guidelines were produced. This article summarises the issues identified in the development of interventional cardiology particularly DES and the requirement for ongoing antiplatelet therapy. The article reviews the treatment protocols that are still applicable for the different devices that have been deployed in clinical practice.

Percutaneous Coronary Interventional Treatment for Coronary Artery Disease and the Role of Antiplaplatelets Therapy: A Review of the Literature

Uses of balloon catheters or BMS for the treatment of coronary artery lesions shows good short-term results but long-term follow up revealed restenosis in up to 20%-30% of patients. Thus new improvements to balloons and stents are always necessary to achieve the best results from percutaneous coronary intervention (PCI). Drug-eluting stents (DES) improved the principles of bare metal stents (BMS) by local drug release to inhibit neointimal growth. DES reduced the incidence of in-stent restenosis. These benefits and lower costs compared to surgical treatment make the DES an attractive alternative for the treatment of coronary artery disease. Different components of DES which include the polymers, drugs and the stents underwent progressive evolution, and these led to development of new generations of DES with variable types of drugs and polymers to fully absorbable stents. The concern of stent thrombosis still an issue and dual antiplatlets therapy (DAPT) is mandatory for variable time ranging from one month to one year. This article discusses the main available clinical trials in the developments of BMS, DES and the comparison between both with a prospective look at future technologies in the field, in addition to reviewing the current guideline in the uses of DAPT after PCI.

Clinico-Angiographic Profile and Prevalence of Restenosis in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty to Left Main Coronary Artery: An Observational Cohort Study

Background: Patients who underwent percutaneous coronary intervention in left main coronary artery (LMCA) requires special concern, being high risk and increasing patient population. The aim of this study was to assess the clinical profile, angiographic status, and prevalence of restenosis in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in LMCA. Materials and Methods: This observational cohort study included 17 patients who underwent PTCA in LMCA during one-year study period at tertiary care centers in Government Medical College, Kozhikode, India. Data including various risk factors, clinical and angiographic details, stent used, procedural complications and outcomes including rate of restenosis were analyzed. Results: A total of 17 patients (mean age 53.88 ± 9.80 years) with 76.47% of males were included in the study. Smoking and hypertension were the most common risk factors presented in 52.94% and 47.06% of patients respectively. Single vessel disease (SVD) of LMCA was the most common pattern observed in 47.10%;the rate of restenosis was observed in 11.76% patients. Revascularization was performed in one patient (5.88%) with coronary artery bypass graft and in one patient (5.88%) with PTCA using drug eluting stent (DES). The overall procedural success was 88.24% in this study. Survival rate was 100% at one-year follow-up period. Conclusion: Our study involved patients who underwent PTCA in LMCA, showed smoking as a most prevalent risk factor for coronary artery disease and SVD as a most common pattern, comparatively low rate of restenosis and 100% of survival rate at one-year follow-up period.

Successful Percutaneous Treatment of Coronary Artery Ectasia with Drug-Eluting Stent

Coronary artery ectasia is well-known but relatively uncommon finding with prevalence ranging from 1.2% to 5.3%. Coronary artery ectasia has been associated with atherosclerosis in approximately half of the cases. Here, we are presenting a case of male patient who experienced myocardial infarction and was diagnosed with coronary artery ectasia in proximal-mid junction of left anterior descending artery with stenotic lesion. The patient was successfully treated with percutaneous transluminal coronary angioplasty.