Coronary Stenting in a Patient With Dual Left Anterior Descending Artery

Double left anterior descending coronary artery (LAD) originating from the left main stem and the right coronary artery (type IV dual LAD) is a extremely rare coronary artery anomaly. We report a case of type IV dual LAD in a patient with history of myocardial infarction and worsening effort angina. The proper LAD and both the circumflex (Cx) and the right coronary (RCA) arteries showed multiple severe stenoses. The patient underwent successful percutaneous coronary intervention.     

SequentiaI RevascuIarization of Intramuscular Left Anterior Descending Coronary Artery

A bstract We present a new technique for avoiding possible kinking or angulation of the sequential left internal mammary artery to left anterior descending artery (LIMA-LAD) anastomoses when the LAD follows an intramuscular course. A 3- to 5-mm cusp of saphenous vein segment is interposed between the intramuscular LAD segment and internal mammary artery (IMA) at the sequential anastomotic site, to which the distal portion of the IMA was anastomosed in standard end-to-side fashion.     

Cutting Balloon Angioplasty for Ostial Lesions of the Left Anterior Descending Artery

We evaluated the effectiveness of Cutting Balloon angioplasty for ostial lesions of the left anterior descending artery compared with conventional balloon angioplasty. Cutting Balloon angioplasty (n = 7) produced larger acute gain (1.70 ± 0.37 vs 0.48 ± 0.25 mm, P < 0.001) and smaller late loss index (0.54 ± 0.55 vs 1.32 ± 0.81, P < 0.05) than conventional balloon angioplasty (n = 7). As a result, late restenosis was seen in only two patients undergoing Cutting Balloon angioplasty, but in all seven patients undergoing conventional balloon angioplasty. Ostial lesions of the left anterior descending artery may be one of the suitable targets of Cutting Balloon angioplasty . (J Interven Cardiol 2000;13:7–14)     

Dual Left Anterior Descending Artery Arising From Left Circumflex Artery With an Intramyocardial Coronary Aneurysm

Dual left anterior descending (LAD) artery is a rare anomaly conventionally classified into 4 types. We present a case of dual LAD artery in which the long LAD artery has arisen from the left circumflex (LCx) artery, a condition not previously included in the 4 defined types. Moreover, the long LAD artery specified here is associated with an intramyocardial coronary aneurysm. To our best knowledge, it is the first time such a coronary artery anomaly has been reported. This case suggests the important role of coronary computed tomography angiography (CTTA) for diagnosis and therapeutic planning for such an anomaly.     

Long-Term Clinical Outcomes of Isolated Ostial Left Anterior Descending Disease Treatment: Ostial Stenting Versus Left Main Cross-Over Stenting

BackgroundThe optimal strategy for treating ostial left anterior descending coronary artery (LAD) disease remains matter of speculation. We evaluated the impact on long-term outcomes of ostial LAD disease treated by means of ostial stenting (the floating-stent) or left main (LM)-to-LAD cross-over stenting.MethodsClinical and instrumental records of 74 consecutive patients with isolated ostial LAD disease, enrolled between the 1st January 2012 and the 1st January 2017 were reviewed. Patients have been stratified according the stenting techniques adopted: ostial stenting (OS) or LM cross-over (CO).ResultsSeventy-four consecutive patients (54 males, mean age 73.39 ± 9.54 years old) have been analyzed. In CO patients the SYNTAX score (16.2 ± 3.3 vs 24.1 ± 2.5, p < 0.0001) and the percentages of rotablation resulted higher than in OS group. IVUS has been predominantly used in CO groups revealing a significant extension of plaque burden of at least 10 mm of LM proximal to the LAD ostium in all the 18 out of 21 patients (85.7%) undergone IVUS-guided procedure. Fluoroscopy time and contrast medium volume were higher in OS versus CO group of patients. On a mean follow-up of 49.7 ± 7.9 months, MACE and target vessel revascularization (TVR) were 21.0% and 21.0% in OS groups versus 10.1 and 5.6% in the CO group (p = 0.20 and p = 0.04, respectively). Restenosis was higher in the OS than in CO group of patients and was located angiographically at the ostium.ConclusionsOn long-term follow-up CO seems to be superior to OS technique for isolated ostial LAD disease especially in the presence of heavy calcification.