Left main stenting: Now and future

Abstract

For several decades, based on clinical trials comparing coronary-artery bypass grafting (CABG) with medical therapy, bypass surgery has been regarded as the treatment of choice for patients with unprotected left main coronary artery (LMCA) disease. However, because of marked advancements in the techniques of percutaneous coronary intervention (PCI) with stenting and CABG and adjunctive pharmacologic therapy, reevaluation and review of current indications for optimal revascularization therapy for LMCA disease are required to determine the standard of care for these patients. The available current evidence suggests that the composite outcome of death, myocardial infarction and stroke is similar in patients with LMCA disease who are treated with either PCI with stenting or CABG, the only difference being the rate of repeat revascularization. Cumulative and emerging data from several extensive registries and a large clinical trial may have prompted many interventional cardiologists to select PCI with stenting as an alternative revascularization strategy for such patients. In addition, these data not only may change future guidelines, but support the need for prospective, large randomized trials comparing the 2 revascularization treatments. Finally, this evidence will change the current clinical practice of revascularization strategy for unprotected LMCA disease.