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This study aimed to assess the safety & medium/long-term outcome of using double-stenting strategy on left main (LM) stem for the treatment of significant suboptimal angiographic result after initial left main coronary artery (LMCA) stent implantation. Between August 2005 & June 2010, patients undergoing PCI with doublestenting of LMCA lesions comprised the study cohort. Baseline characteristics, EuroSCORE (I), lesions & stent characteristics and outcomes were analyzed. Thirty-eight patients were included in the study. Sixty-three percent were male, mean age of 73 years old, 37% were diabetic & 74% had unprotected LMCA stenting. Majority presented with acute coronary syndrome (57%) in which 7 (18%) had STEMI. They represented a high risk cohort with high EuroSCORE (l) (logistic 17.7 ± 19.1%, additive 8.2 ± 4.7). In addition, 32 (84%) patients had multi-vessels disease. Estimated left ventricular ejection fraction in the series was 54 ± 13%. Drug eluting stents were placed in all cases as the first stent (mean size 3.55 ± 0.28mm), 34 (89%) patients had bare metal stent as the second stent (mean size 4.15 ± 0.43mm). All stents were placed successfully. There was no in-hospital death. At one year, for those who survived, no patient required repeat PCI to LMCA lesion and non-target lesion revascularization was 16%. One-year survival was 87% & 82% by the end of second year. In conclusion, favorable outcomes were seen in this unselected series of patients undergoing double-stenting of LM stem lesions. The technique is safe and feasible, provides another option for treatment of severe LMCA disease with suboptimal initial stenting result.

Double-Stenting of the Left Main Coronary Artery lesions: Safety, Clinical Outcome and Long Term Follow-up