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Left main and multivessel revascularisation in 2010 - LIVE from Riga

ESC Congress 2010

Invasive Coronary Imaging and Hemodynamics


J. Fajadet introduced the session and defined the learning objectives. The aim of the session was to analyse the basis of treatment decision-making for a patient with left main /multivessel coronary artery disease by integrating the importance of clinical, functional and angiographic characteristics of the patient.

Doctor I. Narbute from Riga presented the case of a 71 year old male, non diabetic, hypercholesterolemic, symptomatic during effort with ischemic exercice stress test, normal LV function, three vessels diseased including distal left main stenosis. P. Kala from Brno analysed the risk assessment for this particular patient and the value of scores based on clinical (Euroscore, Mayo Clinic score) or angiographic (Syntax score) characteristics.

J. Escaned from Madrid explained the importance of functional evaluation of the coronary artery lesions with the use of FFR. He demonstrated very clearly, from the results of FAMR study, the better clinical outcome after PCI guided by FFR compared to PCI guided by angiography. J. Greenwood from Leeds demonstrated the major impact of diabetes on clinical outcome after PCI with DES implantation. He reported the significant differences in clinical outcome and particularly the higher rate of repeat revascularisation in the diabetic cohort of the Syntax study compared to the non diabetic one ( Banning et al.).

G. Wimmer-Greinecker, cardiac surgeon from Bad Bevensen, explained the technical surgical possibilities offered to this patient and showed the positive results of CABG concerning survival and need for repeat revascularisation.

The Live case was performed by A. Erglis and his team from Riga. All the difficulty of this very interesting case came from a huge dissection of the left main trunk with the guiding catheter successfully treated by emergency stent implantation. LAD lesion was treated by an additional stent with post dilatation guided by IVUS assessment. RCA lesion studied by FFR, was not considered as functionally significant and consequently was not attempted.

Finally, AP Kappetein, cardiac surgeon from Rotterdam, delivered the take-home message indicating clearly the need for a multi disciplinary approach and medical surgical meeting in order to propose the best treatment option for the patients with multi vessel coronary artery disease.

References


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Left main and multivessel revascularisation in 2010 - LIVE from Riga

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.