Current Interventions for the Left Main Bifurcation

• Published in: JACC. Cardiovascular interventions 2017-05, Vol.10 (9), p.849-865
• Main Authors: Rab, Tanveer, MD, Sheiban, Imad, MD, Louvard, Yves, MD, Sawaya, Fadi J., MD, Zhang, Jun Jie, MD, Chen, Shao Liang, MD
• Format: Article
• Language: English
• Subjects: bifurcation; Cardiovascular; Coronary Angiography; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Drug-Eluting Stents; Humans; left main; Patient Selection; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Risk Factors; stenting techniques; Treatment Outcome
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2017.02.037

Abstract Contemporary clinical trials, registries, and meta-analyses, supported by recent results from the EXCEL (Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease) and NOBLE (Percutaneous Coronary Angioplasty Versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis) trials, have established percutaneous coronary intervention of left main coronary stenosis as a safe alternative to coronary artery bypass grafting in patients with low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) scores. As left main percutaneous coronary intervention gains acceptance, it is imperative to increase awareness for patient selection, risk scoring, intracoronary imaging, vessel preparation, and choice of stenting techniques that will optimize procedural and patient outcomes.