Percutaneous coronary intervention to treat unprotected left main: Common (un-answered) challenges

Harnessing drug-coated balloons for the management of left main coronary disease: A promising strategy?

“…In clinical practice, management of unprotected left main stem (LMS) stenoses with percutaneous coronary intervention (PCI) has been quite challenging, particularly in the presence of bifurcation or aorto-ostial stenoses [1][2][3]. In this context, certain stentbased PCI techniques have been described as having variable safety and efficacy [1]. In their recently published article, Kovacevic M, et al [1] have reviewed a variety of issues associated with unprotected LMS stenting.…”

“…In this context, certain stentbased PCI techniques have been described as having variable safety and efficacy [1]. In their recently published article, Kovacevic M, et al [1] have reviewed a variety of issues associated with unprotected LMS stenting. We fully agree with the suggested challenges and their management strategies [1].…”

“…In their recently published article, Kovacevic M, et al [1] have reviewed a variety of issues associated with unprotected LMS stenting. We fully agree with the suggested challenges and their management strategies [1]. However, we also would like to underscore the potential clinical value of drug-coated balloons (DCBs) in management of LMS disease.…”

Percutaneous coronary intervention to treat unprotected left main: Unmet needs

“…We read with much interest the article by Kovacevic et al [1] about modern dilemmas in interventional treatment of the left main (LM) disease. The authors described clearly and provided solutions for imaging and functional assessment modalities, procedural issues, and options for overcoming hemodynamic instabilities during the procedure.…”

“…This "low SYNTAX" score often translates to "low-risk" patients, commonly signifying normal systolic function and an absence of significant comorbidity. Yet those at "high risk" or frail and elderly patients, as Kovacevic et al [1] stated, could benefit from PCI supported by decongestive strategies such as Impella (Abiomed, Danvers, MA, USA) or iVAC 2L (PulseCath, Amsterdam, The Netherlands), by simply avoiding surgery. How many patients with successful surgery and unfavorable postoperative course have we seen?…”