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左主干支架

科研文章

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Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III Study Impact of SYNTAX Score on 10-Year Outcomes After Revascularization for Left Main Coronary Artery Disease Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club Bayesian Interpretation of the EXCEL Trial and Other Randomized Clinical Trials of Left Main Coronary Artery Revascularization Safety of intermediate left main stenosis revascularization deferral based on fractional flow reserve and intravascular ultrasound: A systematic review and meta-regression including 908 deferred left main stenosis from 12 studies Optimizing outcomes during left main percutaneous coronary intervention with intravascular ultrasound and fractional flow reserve: the current state of evidence Incidence and Management of Restenosis After Treatment of Unprotected Left Main Disease With Second-Generation Drug-Eluting Stents (from Failure in Left Main Study With 2nd Generation Stents-Cardiogroup III Study) EXCELling in Left Main Intervention Revascularization of left main coronary artery 10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease

Review Article2018 Nov 20. [Epub ahead of print]

JOURNAL:Cardiovasc Revasc Med. Article Link

Revascularization of left main coronary artery

Baydoun H, Jabbar A, Nakhle A et al. Keywords: Left main coronary artery ; CABG; PCI; IVUS-guidance; high surgical risk; DES; atherectomy techniques;

ABSTRACT

Highlights

  • - CABG is still the preferred way to treat patients with unprotected left main disease (UPLMD).
  • - PCI is a reasonable approach mainly in patients with high surgical risk and non-complex anatomy (Syntax score <33).
  • - IVUS-guided PCI is associated with lower risks of all-cause death, cardiac death, TVR and in-stent thrombosis.
  • - FFR is feasible but less validated than IVUS for LM disease and should be used in correlation with IVUS.
  • - DK crush is favored over other techniques for true distal LM bifurcation with lower rates of MI, stent thrombosis and TLR.


Left main coronary artery (LMCA) disease affect 5-7% of patient undergoing coronary angiography and is associated with multivessel CAD in 70% of the cases. Untreated significant LMCA disease is associated with significant mortality and morbidity. CABG is the traditional therapy for revascularization in LMCA disease. PCI is a reasonable alternative mainly in patients with high surgical risk or other specific factors. Drug-eluting stents, improved antiplatelet therapeutic options, atherectomy techniques, IVUS-guidance and improved operator experience have all contributed to the observed improvement in clinical outcomes. Given the large number of variables involved in deciding between PCI and CABG, a heart team should make decisions regarding revascularization of LMCA disease.