Stenting Versus Surgery for Significant Left Main Disease

Abstract

For decades, coronary artery bypass grafting (CABG) has been the choice of revascularization strategy for significant left main coronary artery (LMCA) disease. However, with marked technological advances in less invasive percutaneous strategies, such as drug-eluting stents, and potent adjunctive pharmacology, percutaneous coronary intervention (PCI) has been increasingly accepted as an alternative to CABG for selected cases with LMCA disease. The available evidence from randomized clinical trials and adequately sized, real-world registries suggest that hard clinical endpoints (death, myocardial infarction, or stroke) were comparable between two treatment strategies at short- and mid-term follow-up, while higher rate of repeat revascularization are observed after PCI. Current guidelines state that PCI for LMCA disease is reasonable in patients with low to intermediate anatomic complexity and those who are at increased surgical risk. Ongoing large-sized clinical trials comparing newer-generation drug-eluting stents and CABG would provide important clinical insights to guide optimal strategy for patients with significant LMCA disease in the (near) future.

Efficacy and safety of shockwave intravascular lithotripsy (S-IVL) in calcified unprotected left main percutaneous coronary intervention – short-term outcomes

“…However, it is more common in the acute coronary syndrome setting. Furthermore, due to the aging process and numerous comorbidities, the number of patients with a high risk of surgical intervention or disapproving of such therapy is instantly growing [2]. Since left main disease is related to the large myocardial ischemic territory, the high-risk patients are frequently qualified for rescue percutaneous procedures.…”

One-year Outcome of Different Unprotected Left Main Percutaneous Coronary Interventions Techniques in Acute Coronary Syndromes

“…In the later years, there were great advances in the medical device technology and percutaneous coronary intervention (PCI) techniques. PCIs became more popular with better outcomes due to these factors together with the advances in the adjunctive medical therapy and personal experiences [5], [6].…”

Drug-eluting stent placement versus coronary artery bypass surgery for unprotected left main coronary artery disease: A meta-analysis of randomized controlled trials

“…CABG has been the standard of care for the revascularization of critical LMCA on the basis of early clinical trials demonstrating a definitive survival benefit of CABG over medical therapy . Because of recent advances in medical device technology, procedural techniques, antithrombotic agents, and potent adjunctive medical therapy, PCI with stenting for LMCA disease has become technically feasible with favorable clinical outcomes . We conducted this meta‐analysis to review the results of the latest clinical trials between the two treatment strategies.…”

“…8,9 Because of recent advances in medical device technology, procedural techniques, antithrombotic agents, and potent adjunctive medical therapy, PCI with stenting for LMCA disease has become technically feasible with favorable clinical outcomes. [10][11][12] We conducted this meta-analysis to review the results of the latest clinical trials between the two treatment strategies. used the following terms for the search: "left main," "left main coronary artery," "LMCA," "CABG," "coronary artery bypass surgery," "PCI," "percutaneous coronary intervention," "stent," "DES," and "drug eluting stent."…”