Case Report: Dedicated Distal Left Main Coronary Stent Implantation ─Simplicity and Achievable Outcome

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Damras Tresukosol, MD, FSCAI, FAPSIC


An 81-year-old Vietnamese man presented with worsening angina, with previous coronary angiography and intravascular ultrasonography findings with ostial left anterior descending artery (LAD) narrowing. He flew to our center for a second opinion. We offered intracoronary optical coherence tomography (OCT) evaluation for the measurement of critical ostial LAD, minimal lumen area (MLA). Provisional stent implantation to left main (LM) bifurcation (MEDINA 0,1,0) with dedicated self-apposing stent was performed with good angiographic result and mid-term follow up without major adverse event.

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Tresukosol, MD, FSCAI, FAPSIC D. Case Report: Dedicated Distal Left Main Coronary Stent Implantation ─Simplicity and Achievable Outcome. BKK Med J [Internet]. 2022 Feb. 26 [cited 2024 Feb. 22];18(1):28. Available from:
Case Report


1. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention 2019;14:1435-534.
2. Brilakis ES, Rao SV, Banerjee S, et al. Percutaneous coronary intervention in native arteries versus bypass grafts in prior coronary artery bypass grafting patients: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv 2011;4:844-50.
3. Stone GW, Sabik JF, Serruys PW, et al. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med 2016;375:2223-35.
4. Serruys PW, Cavalcante R, Collet C, et al. Outcomes After Coronary Stenting or Bypass Surgery for Men and Women With Unprotected Left Main Disease: The EXCEL Trial. JACC Cardiovasc Interv 2018;11:1234-43.
5. Makikallio T, Holm NR, Lindsay M, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet 2016;388:2743-52.
6. Holm NR, Makikallio T, Lindsay MM, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet 2020;395:191-9.
7. Banning AP, Lassen JF, Burzotta F, et al. Percutaneous coronary intervention for obstructive bifurcation lesions: the 14th consensus document from the European Bifurcation Club. EuroIntervention 2019;15:90-8.
8. Laukkanen JA, Kunutsor SK, Niemela M, Kervinen K, Thuesen L, Makikallio TH. All-cause mortality and major cardiovascular outcomes comparing percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: a meta-analysis of short-term and long-term randomised trials. Open Heart 2017;4:e000638.
9. Ben-Yehuda O, Chen S, Redfors B, et al. Impact of large periprocedural myocardial infarction on mortality after percutaneous coronary intervention and coronary artery bypass grafting for left main disease: an analysis from the EXCEL trial. Eur Heart J 2019;40:1930-41.
10. Murasato Y, Mori T, Okamura T, et al. Efficacy of the proximal optimization technique on crossover stenting in coronary bifurcation lesions in the 3D-OCT bifurcation registry. Int J Cardiovasc Imaging 2019;35:981-90.
11. AJJ IJ, Simsek C, van Driel AG, et al. Comparison between the STENTYS self-apposing bare metal and paclitaxel-eluting coronary stents for the treatment of saphenous vein grafts (ADEPT trial). Neth Heart J 2018;26:94-101.
12. Jilaihawi H, Farah B, Laborde JC. The use of self-expanding stents in coronary bifurcations and beyond: a paradigm revisited. EuroIntervention 2009;4:669-75.
13. Briguori C, Visconti G, Donahue M, et al. The STENTYS(R) paclitaxel-eluting stent in the treatment of unprotected distal left main. Catheter Cardiovasc Interv 2015;86:E131-9.
14. Golino M, Nuzzo S, Briguori C. STENTYS coronary system: current status and future direction. Minerva Cardiol Angiol 2021;69:201-14.
15. Medina A, Suarez de Lezo J, Pan M. [A new classification of coronary bifurcation lesions]. Rev Esp Cardiol 2006;59:183.
16. Escaned J, Collet C, Ryan N, et al. Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. Eur Heart J 2017;38:3124-34.
17. Zlotnick DM, Ramanath VS, Brown JR, Kaplan AV. Classification and treatment of coronary artery bifurcation lesions: putting the Medina classification to the test. Cardiovasc Revasc Med 2012;13:228-33.
18. Perl L, Witberg G, Greenberg G, Vaknin-Assa H, Kornowski R, Assali A. Prognostic significance of the Medina classification in bifurcation lesion percutaneous coronary intervention with second-generation drug-eluting stents. Heart Vessels 2020;35:331-9.
19. Hall AB, Chavez I, Garcia S, et al. Double kissing crush bifurcation stenting: step-by-step troubleshooting. EuroIntervention 2021;17:e317-e25.
20. Pescetelli I, Ricci F, Zimarino M. In complex coronary bifurcations, should a dedicated stent be better than a dedicated approach? Cardiovasc Revasc Med 2019;20:181-2.
21. Kang SJ, Lee JY, Ahn JM, et al. Intravascular ultrasound-derived predictors for fractional flow reserve in intermediate left main disease. JACC Cardiovasc Interv 2011;4:1168-74.
22. Chen X, Li X, Zhang JJ, et al. 3-Year Outcomes of the DKCRUSH-V Trial Comparing DK Crush With Provisional Stenting for Left Main Bifurcation Lesions. JACC Cardiovasc Interv 2019;12:1927-37.
23. Waksman R, Rogers T. Left Main Revascularization: One Size Does Not Fit All. JACC Cardiovasc Interv 2018;11:1244-6.
24. Xue H, Luo Z, Brown T, Beier S. Design of Self-Expanding Auxetic Stents Using Topology Optimization. Front Bioeng Biotechnol 2020;8:736.
25. A IJ, Verheye S. First report on the use of a novel self-expandable stent for treatment of ST elevation myocardial infarction. Catheter Cardiovasc Interv 2009;74:850-4.
26. Garcia Garcia J, Garcia Carrascal P, Castro Ruiz F, Manuel Martin F, Fernandez JA. Effects of bifurcation-specific and conventional stents on coronary bifurcation flow. An experimental and numerical study. J Biomech 2017;54:64-72.
27. Laborde JC, Borenstein N, Behr L, Ramcharitar S. Stentys coronary bifurcation stent. EuroIntervention 2007;3:162-5.
28. Yew KL, Kang Z. First-in-man unprotected left main stenting with Stentys Xposition S self-apposing sirolimus eluting stent and optical coherence tomography guidance: The emerging panacea for left main intervention. Int J Cardiol 2015;201:628-30.
29. Wanha W, Mielczarek M, Smolka G, et al. Safety and efficacy of self-apposing Stentys drug-eluting stent in left main coronary artery PCI: Multicentre LM-STENTYS registry. Catheter Cardiovasc Interv 2019;93:574-82.
30. Kidawa M, Chizynski K, Kacprzak M, Ledakowicz-Polak A, Zielinska M. Self-expanding STENTYS stents in daily routine use. Kardiol Pol 2017;75:554-63.
31. Yew KL. Optimization of Stentys Xposition S self-apposing sirolimus eluting stent expansion and apposition with coronary lesion debulking strategy utilizing cutting balloon. Int J Cardiol 2016;203:1007-8.
32. Prati F, Romagnoli E, Burzotta F, et al. Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study. JACC Cardiovasc Imaging 2015;8:1297-305.