Left main intervention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editors-In-Chief: Neil M. Gheewala, M.D.; Anthony Smeglin, M.D.
Background
Approximately 5% of all patient undergoing coronary angiography have significant (> 50%) left main coronary artery (LMCA) stenosis. The ACC/AHA recommends coronary artery bypass grafting (CABG) in patient with significant LMCA disease who have angina and ACS. However, not all patients are operative candidates. In selected patients, LM PCI can safely and effectively treat patients in whom coronary artery bypass grafting (CABG) is suboptimal, or have prior CABG with a ‘protected’ LMCA. ‘Protected’ left main in patients with prior CABG is defined as at least one patent graft to left anterior descending or circumflex artery.
Goals of Treatment
The main goal of treatment is to provide a treatment option in patients who would otherwise be poor surgical candidates, declined by surgery, or refuse CABG. It is essential to properly select patients based on their anatomy who would be better candidates for DES vs BMS vs bifurcation stents.
Treatment Choices
Medical Therapy
Treating a patient with non-surgical methods include smoking cessation and risk factor modification. If a stent is placed, the patient is placed on prolonged dual antiplatelet therapy.