Atherectomy of the left main coronary artery with percutaneous cardiopulmonary bypass support

Abstract

Left main (LM) coronary artery stenoses have conventionally been precluded from percutaneous coronary angioplasty because of the prohibitive risk of irreversible hemodynamic collapse after acute closure of the artery, and a relatively high risk of late sudden death.1 When protected by left anterior descending and circumflex coronary artery by-pass grafts, angioplasty of the LM coronary artery can be safely performed but is limited by a rate of recurrent stenosis in excess of 50%.2 Coronary atherectomy has recently been advocated as an alternative procedure because of preliminary data suggesting a lower incidence of acute closure and restenosis after peripheral atherectomy.3 A percutaneous cardiopulmonary support system has also been reported to reduce the hazards of high risk conventional angioplasty including angioplasty of the LM coronary artery.4 We report the successful combined use of percutaneous cardiopulmonary bypass and LM coronary atherectomy in a patient incompletely protected by aortocoronary bypass grafts.