Background:Treatment of left main coronary artery(LMCA) bifurcation lesions remained challenging, even with drug-eluting stents. So,we report intravascular ultrasound(IVUS) findings after simultaneous kissing stenting(SKS) of LMCA
bifurcation lesions.Methods : From May 2004 to January 2007, 16 patients with LMCA bifurcation lesions, who underwent SKS and completed both stents post-intervention IVUS, were included. IVUS analysis was performed at 3 distinct zone of both stent separately:proximal-double barrel(two stents seen on IVUS),middle-carina(2.5mm length back and forth the intersection point of two stents),distal-single barrel(only one stent seen on IVUS).Stent under-expansion was defined as minimal stent area(MSA) under 5mm2 on IVUS and restenosis was defined as %diameter stenosis over 50% on follow up angiography. Also,we evaluated long term angiographic and clinical results during follow-up period.Results:16 patients (32 lesions, 28 Sirolimus-eluting stent and 4 Paclitaxel-eluting stent )were enrolled. Average stent diameter and length of both LAD and LCX stents were similar, respectively. Overall,the MSA of LCx was smaller than the LAD (5.26±1.05 vs. 6.13±1.47mm2, P=0.035). When both stents were considered separately, the MSA was found at the middle zone in 93.8% of both stents, respectively. Stent under-expansion was found in 11 out of 32 lesions (34.8 %) and more frequently in LCx stents than LAD stents (56.3% vs. 12.5%, p=0.009), all of which occurred at the middle zone. Clinical information was gathered in all patients at a mean follow-up of 27.69±10.40 months. During follow-up period, major adverse cardiac events(MACE) developed in 7 patient(43.75%) who developed death( 3 patient;12.5% ),target lesion revascularization (4 patients ; 25.0%) and myocardial infarction(1 patient;6.75%).The restenosis was occurred 3 patients in LCX stents and 1 patients in LAD stents(18.75% vs. 6.75%,P=0.6 ),especially at middle zone. Conclusion : In LMCA bifurcation lesions treated with simultaneous kissing stenting, stent under-expansion was found more frequently in LCX than LAD stents, which occurred especially in middle-carina zone. This may contribute to a higher event rate including restenosis at this zone.
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