Stenting a Good Option for Left Main Heart Artery

Aug. 20 -- WEDNESDAY, Aug. 19 (HealthDay News) -- Twelve-year data on treatment of blockage of the left main heart artery indicate that using a drug-coated stent is an effective alternative to bypass surgery, doctors report.

The study of 314 people who underwent the procedure between 1997 and 2008 in Poland supports the findings of a large European trial, which found no difference in the death rate between bypass surgery and angioplasty for the condition, according to a report published online Aug. 19 and in an upcoming print issue of the Journal of the American College of Cardiology by a group of physicians from Poland and the United States.

While no more than 5 percent of cases of coronary artery disease involve the left main artery, there has been controversy about the best treatment, in part because the vessel supplies blood to two-thirds of the heart muscle.

"In the earliest days, it was found that surgical revascularization [restoration of blood flow] prolonged survival," said Dr. David R. Holmes, the Scripps professor of medicine at the Mayo Graduate School of Medicine, and a participant in the earlier European trial.

While the left main vessel is an easy target for insertion of a balloon that is expanded to widen the artery, concerns that the procedure would not prevent the artery from closing again limited its use, Holmes said. But the arrival of stents -- thin metal tubes that help keep the artery open -- and then of stents coated with drugs to prevent clotting, made the procedure more feasible, he said.

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The SYNTAX study, sponsored by stent maker Boston Scientific Inc. and reported last year, found no difference in the mortality rate between people who had angioplasty and stent implants, and those who had bypass surgery.

"It showed that selected patients with left main disease could be treated with drug-eluting stents," Holmes said.

The newly reported study helps show that "in some patients, not a majority, angioplasty is a very satisfactory alternative to bypass surgery," Holmes added.