Left Main Percutaneous Coronary Revascularization.

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Left main (LM) coronary artery disease represents a significant portion of percutaneous coronary interventions (PCI).
• Evidence supports LM PCI non-inferiority, particularly for low SYNTAX score patients, influencing current guidelines.
• Conflicting data exist regarding single vs. upfront two-stent strategies for distal LM disease.

Purpose of the Study:

• To review contemporary trials and their implications for current left main percutaneous coronary interventions.
• To highlight the evolving role of stenting strategies and mechanical circulatory support in LM PCI.
• To address the limited data on image-guided PCI and mechanical circulatory support in LM disease.

Main Methods:

• Review of landmark trials (EXCEL, NOBEL, EBC Main, DKCRUSH-V) and contemporary studies.
• Analysis of guideline recommendations from the European Society of Cardiology.
• Evaluation of data on stenting techniques, imaging guidance, and mechanical circulatory support in LM PCI.

Main Results:

• LM PCI is a viable revascularization option, with guidelines reflecting its use.
• Stenting strategies for distal LM disease show conflicting outcomes between stepwise and upfront two-stent approaches.
• Limited data exist on the specific benefits of imaging guidance and mechanical circulatory support in LM PCI, despite observed clinical practice trends.

Conclusions:

• Contemporary trials provide evidence for LM PCI, but optimal stenting strategies for specific LM disease locations remain debated.
• Further research is needed to clarify the role and benefit of imaging guidance and mechanical circulatory support in LM PCI.
• Clinical practice should be guided by evidence, particularly regarding the judicious use of mechanical circulatory support in LM PCI.