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Stenting Left Main

Abstract

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What Is the Optimal Revascularization Strategy for Left Main Coronary Stenosis? Current treatment of significant left main coronary artery disease: A review Why NOBLE and EXCEL Are Consistent With Each Other and With Previous Trials Comparison of Outcomes of Percutaneous Coronary Intervention on Native Coronary Arteries Versus on Saphenous Venous Aorta Coronary Conduits in Patients With Low Left Ventricular Ejection Fraction and Impella Device Implantation Achieved or Attempted (from the PROTECT II Randomized Trial and the cVAD Registry) Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club Patient selection and percutaneous technique of unprotected left main revascularization
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Review Article2018 Jan 17;20(1):3.

JOURNAL：Curr Atheroscler Rep. Article Link

The Current State of Left Main Percutaneous Coronary Intervention

Avula HR, Rassi AN Keywords: Coronary artery bypass grafting; Intravascular ultrasound; Left main; Left main coronary artery disease; Percutaneous coronary intervention; Randomized control trial; Revascularization

ABSTRACT


PURPOSE OF REVIEW - While coronary artery bypass grafting (CABG) remains the standard of care, advances in stenting technology and procedural technique are changing the role of percutaneous coronary intervention (PCI) in the treatment of severe left main coronary artery (LMCA) disease. We review contemporary evidence comparing PCI and CABG for the treatment of severe LMCA disease, discuss optimal techniques during leftmain PCI, and provide guidance on studied revascularization strategies within specific patient subgroups.


RECENT FINDINGS - Results from randomized control trials of patients treated with PCI or CABG for severe LMCA disease demonstrate comparable short- and mid-term rates of death, myocardial infarction (MI), and stroke, but increased rates of repeat or target-vessel revascularization after PCI. Though extended follow-up data has suggested lower long-term rates of MI and stroke in patients with severe LMCA disease treated with CABG, results from patients undergoing PCI with second-generation drug-eluting stents (DES) demonstrate non-inferiority in these outcomes. These findings are generalizable to patients with severe LMCA disease having low to intermediate anatomic complexity. Intravascular ultrasound and double kissing (DK) crush stenting also reduce adverse event rates among patients undergoing left main PCI and improve long-term outcomes. In patients with severe LMCA disease having low to intermediate anatomic complexity, both CABG and PCI with second-generation DES are effective methods of revascularization with comparable long-term rates of death, MI, and stroke. The roles of multi-vessel coronary artery disease and anatomic complexity on long-term outcomes after CABG or PCI for severe LMCA disease remain under investigation.

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