Should the asymptomatic patient with a significant proximal LAD stenosis undergo PTCA?

The approach to a proximal LAD stenosis in an asymptomatic patient depends on a number of factors. Most important among these are the presence and extent of ischemia, anatomic considerations, and the functional status of the myocardium subserved by the vessel. In patients with functionally and hemodynamically insignificant disease with no ischemia, it is appropriate simply to follow the patient and to modify the risk factors for atherosclerosis if they exist. All three of the currently available modalities are appropriate in individual patients, including medical management, percutaneous balloon angioplasty, and surgical revascularization. In ambiguous cases, the available studies suggest no benefit from aggressive strategies; therefore, a conservative approach that minimizes side effects and complications of treatment is best.