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Review
. 2022;18(1):e170621194128.
doi: 10.2174/1573403X17666210617094735.

The Contemporary Management of Left Main Coronary Artery Disease

Jonathan A Mailey  1 , Mark S Spence  1
Affiliations
Review

The Contemporary Management of Left Main Coronary Artery Disease

Jonathan A Mailey et al. Curr Cardiol Rev. 2022.

Abstract

The 'gold standard' in the management of left main coronary artery disease has historically been coronary artery bypass surgery. Recent innovations in drug-eluting stent technology coupled with the increasing utility of physiology and imaging guidance for procedures have led to an evolving role of percutaneous coronary intervention in left main disease of low and intermediate anatomical complexity. This revascularization modality carries the clear advantage of being less invasive and significantly reduced recovery times. This practice is currently supported by international guidelines, however, it remains a controversial topic in the field of interventional cardiology, and the long-term outcomes of a percutaneous strategy have been questioned. This review describes the current evidence base for the assessment and choice of intervention in left main coronary artery disease. The percutaneous revascularization techniques and use of imaging to optimize procedures and improve clinical outcomes have been discussed.

Keywords: Left main coronary artery disease; coronary artery bypass graft surgery; intravascular imaging; left main coronary interventions; percutaneous coronary intervention; revascularization of stable coronary artery.

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References

    1. Head S.J., Milojevic M., Daemen J., Ahn J.M., Boersma E., Christiansen E.H., Domanski M.J., Farkouh M.E., Flather M., Fuster V., Hlatky M.A., Holm N.R., Hueb W.A., Kamalesh M., Kim Y.H., Mäkikallio T., Mohr F.W., Papageorgiou G., Park S.J., Rodriguez A.E., Sabik J.F., III, Stables R.H., Stone G.W., Serruys P.W., Kappetein A.P. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: A pooled analysis of individual patient data. Lancet. 2018;391(10124):939–948. doi: 10.1016/S0140-6736(18)30423-9. - DOI - PubMed
    1. Maron D.J., Hochman J.S., Reynolds H.R., Bangalore S., O’Brien S.M., Boden W.E., Chaitman B.R., Senior R., López-Sendón J., Alexander K.P., Lopes R.D., Shaw L.J., Berger J.S., Newman J.D., Sidhu M.S., Goodman S.G., Ruzyllo W., Gosselin G., Maggioni A.P., White H.D., Bhargava B., Min J.K., Mancini G.B.J., Berman D.S., Picard M.H., Kwong R.Y., Ali Z.A., Mark D.B., Spertus J.A., Krishnan M.N., Elghamaz A., Moorthy N., Hueb W.A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T.D., Szwed H., Doerr R., Keltai M., Selvanayagam J.B., Steg P.G., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N.O., Harrell F.E., Jr, Rockhold F.W., Broderick S., Ferguson T.B., Jr, Williams D.O., Harrington R.A., Stone G.W., Rosenberg Y., ISCHEMIA Research Group Initial invasive or conservative strategy for stable coronary disease. N. Engl. J. Med. 2020;382(15):1395–1407. doi: 10.1056/NEJMoa1915922. - DOI - PMC - PubMed
    1. The veterans administration coronary artery bypass surgery cooperative study group. Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. N. Engl. J. Med. 1984;311(21):1333–1339. doi: 10.1056/NEJM198411223112102. - DOI - PubMed
    1. Varnauskas E. Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. N. Engl. J. Med. 1988;319(6):332–337. doi: 10.1056/NEJM198808113190603. - DOI - PubMed
    1. Passamani E., Davis K.B., Gillespie M.J., Killip T. A randomized trial of coronary artery bypass surgery. Survival of patients with a low ejection fraction. N. Engl. J. Med. 1985;312(26):1665–1671. doi: 10.1056/NEJM198506273122603. - DOI - PubMed

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