Drug-eluting stents for left main coronary artery stenosis: case selection and technical issues

The use of coronary stents for the treatment of left main coronary artery (LMCA) stenosis is feasible and is associated with a high rate of procedural success and low rates of early and late complications, such as death, myocardial infarction, and stent thrombosis, in low-risk patient populations. Patients at high risk for coronary artery bypass grafting (CABG), however, have reduced event-free survival after stenting. Compared with bare-metal stents for LMCA disease, the subsequent rate of target lesion revascularization appears to be diminished by use of drug-eluting stents (DESs), with similar or enhanced survival and freedom from myocardial infarction. Intravascular ultrasonographic guidance during the procedure is strongly encouraged to assess the lesion, select an appropriate stenting technique, and achieve optimal stent placement. Results of prospective randomized trials comparing the use of DESs with CABG may be needed to ascertain whether DESs could be a reasonable alternative for patients with LMCA disease.