Left Main PCI—Current Evidence, Techniques, and Triumph

Abstract

The left main coronary artery (LMCA) supplies majority of the left ventricular myocardium and atherosclerotic obstruction is associated with significant myocardial jeopardy. Coronary artery bypass surgery (CABG) has been the gold standard for LMCA disease in the past. The LMCA has special characteristics anatomically, poses different challenges with regard to percutaneous coronary intervention (PCI), and is often associated with multivessel disease. However, advancements in technology have established PCI to be a standard, safe, and reasonable alternative to CABG with comparable outcomes. Contemporary PCI of LMCA disease includes proper selection of the patients and correct technique, and is aided by intravascular ultrasound, optical coherence tomography, and physiological assessment with fractional flow reserve. In this review article, we discuss the anatomy, plaque characteristics of LMCA, current evidence from registries and randomized trials comparing with CABG, technical aspects of stent implantation, adjuvant technologies, mechanical circulatory supports, and triumph of PCI.