Debabrata Dash and Shao-Liang Chen
For several decades, coronary artery bypass grafting (CABG) has been considered as the gold standard treatment of unprotected left main coronary artery (LMCA) disease. However, because of large vessel caliber and anatomic accessibility, percutaneous coronary intervention (PCI) for LMCA has been attractive option for interventional cardiologists. With the marked improvement in technique and technology, PCI has been shown to be feasible for patients with unprotected LMCA stenosis. The recent introduction of drug-eluting stents (DESs), together with advances in pre procedural and post procedural adjunctive pharmacotherapies, has improved outcomes of PCIs of these lesions. The available current evidence comparing efficacy and safety of PCIs using DES and CABG revealed comparable results in terms of safety and a lower need for repeat revascularization for CABG. Still the management can be challenging in high risk anatomic subsets involving LMCA bifurcation lesions and, therefore, an integrated approach combining advanced devices, tailored techniques, adjunctive support of physiologic evaluation, and adjunctive pharmacologic agents should be reinforced to improve clinical outcome.
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