[Left main PCI: Current treatment]

Area of Science:

• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Percutaneous coronary intervention (PCI) is increasingly used for left main coronary artery (LMCA) disease.
• Treatment decisions require multidisciplinary Heart Team validation.
• Established PCI techniques must adhere to the KISSS (Keep it simple, swift and safe) principle.

Purpose of the Study:

• To outline current PCI strategies for LMCA disease.
• To emphasize the importance of specific techniques and imaging in LMCA stenting.

Main Methods:

• Review of current PCI techniques for LMCA treatment.
• Application of the KISSS principle.
• Consideration of provisional stenting versus two-stent strategies.
• Mandatory use of Proximal Optimisation Technique (POT).
• Role of intracoronary imaging.

Main Results:

• Provisional stenting is the preferred first-line approach for LMCA PCI.
• A two-stent strategy is indicated for specific anatomical challenges (e.g., large side branches, ostial stenosis).
• POT is essential for optimal stent deployment in all cases.
• Intracoronary imaging aids in procedural success and potentially improves outcomes.

Conclusions:

• PCI is a safe and effective alternative to bypass surgery for selected LMCA patients.
• Adherence to the KISSS principle and utilization of POT are critical for successful LMCA PCI.
• Intracoronary imaging can enhance procedural results and patient outcomes.