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10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis. The PRECOMBAT-2 (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) study C-reactive protein and prognosis after percutaneous coronary intervention and bypass graft surgery for left main coronary artery disease: Analysis from the EXCEL trial A randomized clinical study comparing double kissing crush with provisional stenting for treatment of coronary bifurcation lesions: results from the DKCRUSH-II (Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions) trial 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 Intravascular Imaging and 12-Month Mortality After Unprotected Left Main Stem PCI: An Analysis From the British Cardiovascular Intervention Society Database Restricted access Mortality After Repeat Revascularization Following PCI or CABG for Left Main Disease: The EXCEL Trial Long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents compared with bare-metal stents Ten-Year All-Cause Death According to Completeness of Revascularization in Patients With Three-Vessel Disease or Left Main Coronary Artery Disease: Insights From the SYNTAX Extended Survival Study Left main coronary angioplasty: early and late results of 127 acute and elective procedures
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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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