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Stenting Left Main

Abstract

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Two-year outcomes following unprotected left main stenting with first vs new-generation drug-eluting stents: the FINE registry. EuroIntervention. 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 ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club 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 Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data 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 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 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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