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Provisional versus elective two-stent strategy for unprotected true left main bifurcation lesions: Insights from a FAILS-2 sub-study Revascularization in Patients With Left Main Coronary Artery Disease and Left Ventricular Dysfunction Management of left main disease: an update Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main and Multivessel Coronary Artery Disease: Do We Have the Evidence? 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 Long-Term Outcomes After PCI or CABG for Left Main Coronary Artery Disease According to Lesion Location 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 Current treatment of significant left main coronary artery disease: A review Two-year outcomes following unprotected left main stenting with first vs new-generation drug-eluting stents: the FINE registry. EuroIntervention. 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

Consensus2018 Jul 20;14(4):e467-e474.

JOURNAL:EuroIntervention. Article Link

Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club

Mintz GS, Lefèvre T, Lassen JF et al. Keywords: left main coronary artery stenosis; obstructive LMCA; IVUS; coronary lumen; vessel wall characteristics; LMCA intervention;

ABSTRACT


Interventional cardiology and coronary stent insertion have an increasing role in the optimal management of left main coronary artery (LMCA) stenosis. Assessing the extent of obstructive disease of the LMCA by angiography alone can be challenging. However, in contrast to the two-dimensional, shadow graphic nature of coronary angiography, intravascular ultrasound (IVUS) is an accurate tomographic technique for assessing both the coronary lumen and the vessel wall characteristics. Consequently, it is a particularly useful technique in imaging the LMCA before, during and after intervention. The European Bifurcation Club (EBC) recommends the use of IVUS during most LMCA interventions. The purpose of this consensus document is to review the available IVUS data on LMCA disease evaluation and treatment. It is a practical guide to show "how and when" to use the imaging modality. It is hoped that a standardisation of the practical approach to imaging may allow consolidation of learning and, ultimately, improve patient outcomes.