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Stenting Left Main

Abstract

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Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBAT Study Complex PCI procedures: challenges for the interventional cardiologist Long-Term Outcomes of Different Two-Stent Techniques With Second-Generation Drug-Eluting Stents for Unprotected Left Main Bifurcation Disease: Insights From the FAILS-2 Study Differential prognostic impact of treatment strategy among patients with left main versus non-left main bifurcation lesions undergoing percutaneous coronary intervention: results from the COBIS (Coronary Bifurcation Stenting) Registry II Long-term outcomes following mini-crush versus culotte stenting for the treatment of unprotected left main disease: insights from the Milan and New-Tokyo (MITO) registry Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data Operator Experience and Outcomes After Left Main Percutaneous Coronary Intervention Long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents compared with bare-metal stents
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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.

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