Revascularization of Left Main Coronary Artery
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.
Abstract
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.