Percutaneous transluminal coronary angioplasty of the very proximal left anterior descending coronary artery lesions

To assess the result of percutaneous transluminal coronary angioplasty (PTCA) of the very proximal left anterior descending (LAD) lesions, 153 consecutive patients undergoing PTCA of LAD were analyzed. The distance of the lesion from the origin of LAD was measured in the right anterior oblique angiogram. Twenty-two patients (group I) had very proximal lesion (0.5 cm from the origin), 39 patients (group II) had intermediate proximal lesion (0.5 cm from the origin, but still before the first septal branch) and 92 patients (group III) had more distal lesion. Tandem lesions necessitating multiple balloon inflation were observed in 9 (40.9%) patients of group I, II (28.2%) patients of group II (excluding those already included in group I) and 23 (25%) patients of group III (excluding those already included in groups I and II). Success rates were 20 (90.9%); 38 (97.4%) and 82 (89.1%) respectively, in group I, II and III. Differences were statistically not significant. Extent of disease as well as degree and morphologic severity did not influence success. No complications occured in any patient of group I. Dissection of the main stem has not observed. One patient of group III developed acute infarction and one patient of group III died. We failed to cross chronic total occlusion in, respectively; 2, 1 and 9 patients of group I, II and III. PTCA of the very proximal LAD can be performed safely with a high success rate.