Published in:
01-07-2019 | Intravascular Ultrasound | Intravascular Imaging (A Truesdell, Section Editor)
Intravascular Ultrasound and Optical Coherence Tomography in the Procedural Planning and Execution of Left Main Coronary Artery Percutaneous Coronary Intervention
Published in: Current Cardiovascular Imaging Reports | Issue 7/2019
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Purpose of Review
Left main coronary artery disease (LMCAD) is a frequently encountered, high-risk presentation of atherosclerosis, traditionally managed with surgical bypass grafting. Percutaneous coronary intervention (PCI) for LMCAD is an increasingly attractive option for patients with low to intermediate complexity disease or patients at extremely high or prohibitive surgical risk. The goal of this review is to outline the current indications and guideline recommendations regarding PCI for LMCAD and the role of intracoronary imaging in optimizing these cases.
Recent Findings
Several recent randomized controlled trials have demonstrated the non-inferiority of PCI in LMCAD compared with CABG. Further, the use of intracoronary imaging techniques (i.e., intravascular ultrasound (IVUS) and optical coherence tomography (OCT)) has an advanced understanding of the features, both pre- and post-intervention, responsible for poor procedural outcomes and the metrics of successful PCI.
Summary
PCI for LMCAD should be considered a viable option for those patients at increased surgical risk with low to intermediate lesion complexity. While not directly evaluated in LMCAD intervention, routine intracoronary imaging use and PCI optimization metrics can help to improve outcomes in LMCAD PCI procedures. Further exploration of intracoronary imaging techniques in LMCAD PCI procedures, as well as the long-term follow-up data comparing patients with LMCAD treated with PCI versus CABG, will more completely define the role of PCI in treating these patients.