The Use of PCI in the Most Challenging Settings

Recent data have shown promising results for the use of percutaneous coronary intervention (PCI) in unprotected left main coronary artery (ULMCA) lesions, with no differences in rates of myocardial infarction or death as compared to surgical revascularization. Additionally, PCI has been shown to be a viable therapeutic option in orthotopic heart transplant (OHT) recipients with coronaries damaged by cardiac allograft vasculopathy (CAV), with procedural success rates in the 91-100% range. The use of PCI for ULMCA lesions resulting from CAV reported highly favorable short- and long-term clinical outcomes up to 60 months in patients with both bare-metal stents and drug-eluting stents. While these data are encouraging, translating these successful outcomes to pediatric patients is difficult as PCI in this population is hindered by technical issues such as smaller femoral and coronary arteries along with the requirement for smaller devices like guiding catheters and stents. However, PCI is certainly viable in the pediatric population, and moreover, the largest and longest study to date of pediatric patients who underwent PCI for CAV has shown that this modality can serve as a palliative bridge for more definitive therapies such as repeat OHT.

Rigved V. Tadwalkar, MD, MS
Michael S. Lee, MD
Division of Cardiology
UCLA Medical Center
Los Angeles, CA

Read the entire article at:

Tadwalkar RV, Lee MS. Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention in a Pediatric Patient With Cardiac Allograft Vasculopathy. 2014;26(11):E156-E160.

For more on ULMCA lesions:

Oyama J, Lee MS. Unprotected left main PCI: status report 2013. J Invasive Cardiol. 2013;25(9):478-482.

Karrowni W, Makki N, Dhaliwal AS, et al. Single versus double stenting for unprotected left main coronary artery bifurcation lesions: a systematic review and meta-analysis. J Invasive Cardiol. 2014;26(6):229-233.

Bernelli C, Chieffo A, Buchanan GL, et al. New-generation drug-eluting stent experience in the percutaneous treatment of unprotected left main coronary artery disease: the NEST registry. J Invasive Cardiol. 2013;25(6):269-275.

Gagnor A, Tomassini F, Romagnoli E, et al. Primary angioplasty in ST-elevation myocardial infarction due to unprotected left-main coronary disease in a high-volume catheterization center without on-site surgery facilities: immediate and medium-term outcome: the STEMI-Placet Registry. J Invasive Cardiol. 2012;24(12):645-649.

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