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(Circulation. 1998;98:1587-1590.)
© 1998 American Heart Association, Inc.

Correspondence

Percutaneous Treatment of Left Main Coronary Stenosis

J. Ernesto Molina, MD

Professor of Surgery Cardiovascular & Thoracic Surgery, University of Minnesota, Minneapolis, Minn

To the Editor:

The multicenter report by Dr Ellis and colleagues¹ of 107 patients with left main coronary obstruction who were not candidates for surgery and in whom an attempt was made to reopen the left main coronary vessel by percutaneous techniques with different devices has significant implications for the cardiac surgeon when the patient is a candidate for a surgical procedure. Ellis et al deserve to be congratulated for this important piece of information.

There have been numerous reports of patients who have undergone direct attempts to widen the left main trunk of the coronary artery to provide antegrade flow when the distal branches are not significantly involved with obstructions. One of the main complications of this approach is early restenosis of the vessel and, occasionally, total occlusion, with fatal consequences for the patient.

It appears that the main trunk of the coronary artery reacts unfavorably to endarterectomy procedures or any type of trauma damaging the intima. Occlusion of the left main artery has been reported after radiofrequency ablation for left-sided tachycardias^{2 3 4} and after PTCAs done in the left coronary system.^{5 6} This has been seen after plain cardiac catheterization when the tip of the catheter injures the intima or when perfusion cannulas are positioned in coronary arteries directly to infuse cardioplegia during aortic valve surgery.^{7 8 9 10}

In our institution, we had a case in which the left anterior descending artery (LAD) and the circumflex had separate origins from the aorta, both showing ostial obstructions. The LAD was given a saphenous . . . [Full Text of this Article]

Stephen G. Ellis, MD

Director, Sones Cardiac Catheterization Laboratories The Cleveland Clinic Foundation, Professor of Medicine, The Ohio State University, Cleveland, Ohio

Hideo Tamai, MD; Masakiyo Nobuyoshi, MD; Kunihiko Kosuga, MD; Antonio Colombo, MD; David R. Holmes, MD; Carlos Macaya, MD; Cindy L. Grines, MD; Patrick L. Whitlow, MD; Harvey J. White, MD; Jeffrey Moses, MD; Paul S. Teirstein, MD; Patrick W. Serruys, MD; John A. Bittl, MD; Michael R. Mooney, MD; Thomas M. Shimshak, MD; Peter C. Block, MD; ; Raimund Erbel, MD

The Cleveland Clinic Foundation, Cleveland, Ohio