Search

Background: The optimal treatment of patients with left main coronary artery (LMCA) dissection during catheter-based procedure remains uncertain., Hypothesis: In cases with significant LMCA dissection occurring during catheter-based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome., Methods: We evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during a catheter-based procedure in 10 patients., Results: Initially, there was no significant stenosis of LMCA segments in these patients. Catheter-induced dissection occurred in eight patients (during diagnostic angiography in three patients and during guiding catheter manipulation in five patients). Two patients suffered dissection in the setting of stent deployment in other vessels. Therefore, bail-out stenting for LMCA dissection was performed in a total of 10 patients. In four patients, hypotension developed and an intra-aortic balloon pump was placed during the procedure. Stents were successfully deployed in all patients; there was no in-hospital mortality. Six-month angiographic follow-up was performed in eight patients. No angiographic restenosis (diameter stenosis > or = 50%) was observed in any patient at follow-up study. During a mean follow-up of 31 +/- 25 months after hospital discharge, there was no major adverse cardiac event (death, myocardial infarction, and target lesion revascularization)., Conclusions: Bail-out LMCA stenting is technically feasible and showed good acute and long-term results in a small series of patients.

The objective of this study was to investigate the clinical features of Korean patients with Brugada syndrome (BS). Between June 1998 and April 2002, 15 consecutive patients with BS (13 men, 2 women; mean age, 44+/-10 years) were identified. Eight patients had experienced at least 1 episode of aborted sudden death, 5 patients had had an episode of syncope or chest pain, and 2 patients were asymptomatic at diagnosis. The electrocardiographics (ECGs) of all patients showed spontaneous ST-segment elevation in leads V(1-3) at baseline and 13 patients (87%) showed transient normalization of the ST-segment elevation during follow-up. Twelve patients received an implantable cardioverter-defibrillator (6 patients with aborted sudden death, 5 patients with syncope or chest pain, 1 asymptomatic patient). During a mean follow-up of 19+/-14 months, arrhythmic events occurred in 5 of the 6 patients with aborted sudden death and in 1 of the 5 patients with syncope or chest pain. None of the asymptomatic patients developed any symptoms suggestive of an arrhythmic event. The clinical and ECG manifestation of BS in Korean patients is diverse, but the dynamic nature of the ST segment provides an important clue to the diagnosis of BS. Recurrence of malignant arrhythmia is extremely high in those patients who initially present with aborted sudden death.