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Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 18-30

Left main stenting: What we have learnt so far?

1 Division of Cardiology, Thumbay Hospital, Ajman, UAE, UAE
2 Division of Cardiology, Nanjing Medical University, Nanjing, China

Correspondence Address:
Dr. Debabrata Dash
Division of Cardiology, Interventional Cardiologist,Thumbay Hospital, P.O Box 4184, Ajman
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IHJI.IHJI_14_18

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For many decades, coronary artery bypass grafting (CABG) has been considered as the gold standard treatment of unprotected left main (LM) coronary artery disease. However, a large vessel caliber and anatomic accessibility makes percutaneous coronary intervention (PCI) an attractive option for interventional cardiologists. The introduction of drug-eluting stents (DESs) along with rapid advancements in techniques, devices, and adjunctive pharmacotherapies has further extended the application of PCI for this subset. 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. Despite recent developments in the field of LM PCI, treatment of distal LM bifurcation lesions continues to pose unique technical challenges to the interventional cardiologists. The provisional one-stent approach has shown more favorable outcome than the two-stent technique, making the former the first-line treatment in most types of LM bifurcation lesions. However, some complex lesions would require two stents from the outset. The complexity of this lesion subset reinforces an integrated approach combining tailored techniques, adjunctive physiological and morphologic evaluation, hemodynamic devices, and pharmacologic agents to improve clinical outcomes.

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