Imaging of Left Main Coronary Artery; Untangling the Gordian Knot

Abstract

Left Main Coronary Artery (LMCA) disease is considered a standout manifestation of coronary artery disease (CAD), because it is accompanied by the highest mortality. Increased mortality is expected, because LMCA is responsible for supplying up to 80% of total blood flow to the left ventricle in a right-dominant coronary system. Due to the significant progress of biomedical technology, the modern drug-eluting stents have remarkably improved the prognosis of patients with LMCA disease treated invasively. In fact, numerous randomized trials provided similar results in one-and five-year survival of patients treated with percutaneous coronary interventions (PCI) -guided with optimal imaging and coronary artery bypass surgery (CABG). However, interventional treatment requires optimal imaging of the LMCA disease, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The aim of this manuscript is to review the main pathophysiological characteristics, to present the imaging techniques of LMCA, and, last, to discuss the future directions in the depiction of LMCA disease.

Efficacy and Safety of Thirty-Day Dual-Antiplatelet Therapy Following Complex Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

“…A plethora of studies have substantiated the clinical significance of IVUS-guided PCI in enhancing short-, mid-, and long-term clinical and angiographic outcomes [32][33][34]. Against this background, Hannan et al observed a progressive escalation in the utilization of IVUS-guided PCI among patients presenting complex vascular lesions, surging from 13.4% in 2014 to 16.5% in 2018 within New York-based healthcare facilities [35]. These observations align with those made by Mentias et al, who reported a discernible uptick in the utilization of IVUS performance in the context of PCI, which rose from 3.0% in 2009 to 6.9% in 2016 within the United States.…”

Thirty-Days versus Longer Duration of Dual Antiplatelet Treatment after Percutaneous Coronary Interventions with Newer Drug-Eluting Stents: A Systematic Review and Meta-Analysis

“…Subanalyses of the existing meta-analyses did not discover any difference between these two time frames’ regimens [ 32 ]. However, stents’ evolution, intravascular imaging progress and interventional techniques’ development will reduce further ischemic complications (MI, stent thrombosis and revascularization) and trials studying 30- with 90-days DAPT will try to resolve this dilemma [ 45 , 46 ].…”

Duration Of Dual Antiplatelet Treatment After Percutaneous Coronary Intervention In Patients With Diabetes: A Systematic Review And Meta-Analysis

“…Moreover, the progress of interventional techniques, invasive imaging, and the development of novel drug-eluted balloons and biodegradable polymer drug-eluting stents could decrease the risk of ischemic events in patients with diabetes. 21,[27][28][29] Whether patients with diabetes having undergone PCI are under higher risk of major bleeding, compared with nondiabetic remains controversial. Although optimal glycemic control may have a cardioprotective role during acute phase of ACS, it was not associated with a reduced incidence of major bleedings.…”

“…Moreover, the progress of interventional techniques, invasive imaging, and the development of novel drug-eluted balloons and biodegradable polymer drug-eluting stents could decrease the risk of ischemic events in patients with diabetes. 21,27–29…”