scholarly journals Left Main PCI—Current Evidence, Techniques, and Triumph

2020 ◽  
Vol 1 (2) ◽  
pp. 86-93
Author(s):  
Pramod Kumar Kuchulakanti
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Current Evidence ◽  
Left Ventricular Myocardium ◽  
Left Main ◽  
Fractional Flow ◽  
Flow Reserve

The left main coronary artery (LMCA) supplies majority of the left ventricular myocardium and atherosclerotic obstruction is associated with significant myocardial jeopardy. Coronary artery bypass surgery (CABG) has been the gold standard for LMCA disease in the past. The LMCA has special characteristics anatomically, poses different challenges with regard to percutaneous coronary intervention (PCI), and is often associated with multivessel disease. However, advancements in technology have established PCI to be a standard, safe, and reasonable alternative to CABG with comparable outcomes. Contemporary PCI of LMCA disease includes proper selection of the patients and correct technique, and is aided by intravascular ultrasound, optical coherence tomography, and physiological assessment with fractional flow reserve. In this review article, we discuss the anatomy, plaque characteristics of LMCA, current evidence from registries and randomized trials comparing with CABG, technical aspects of stent implantation, adjuvant technologies, mechanical circulatory supports, and triumph of PCI.

scholarly journals Duration of myocardial early systolic lengthening for diagnosis of coronary artery disease

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000896 ◽  
Author(s):  
Masatoshi Minamisawa ◽  
Jun Koyama ◽  
Ayako Kozuka ◽  
Takashi Miura ◽  
Tatsuya Saigusa ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Fractional Flow ◽  
Cross Sectional ◽  
Significant Stenosis ◽  
Flow Reserve ◽  
Artery Disease ◽  
The Relationship

ObjectiveMyocardial early systolic lengthening (ESL) duration is prolonged in patients with coronary artery disease (CAD). However, the relationship between the fractional flow reserve (FFR), the current gold standard for evaluating physiological myocardial ischaemia, and ESL has not been studied. The aims of this study were to investigate whether left ventricular (LV) ESL duration could identify patients with CAD, and to examine the relationship between FFR and LV ESL duration.MethodsIn this single-centre, cross-sectional, prospective study of 75 patients with suspected or known CAD, we performed two-dimensional speckle tracking echocardiography at rest on the day before coronary angiography or percutaneous coronary intervention. Apical 3 views were used to examine ESL duration, defined as time from onset of the Q wave to maximum myocardial systolic lengthening.ResultsThirty-five patients had non-significant stenosis. Forty patients with CAD underwent FFR testing: 17 had an FFR≥0.8 and 23 had an FFR<0.8. Global ESL duration was 20.9±22.2 ms in patients with non-significant stenosis, 36.4±23.2 ms in patients with FFR≥0.8 and 39.6±29.5 ms in patients with FFR<0.8 (p=0.020). However, global and regional ESL durations were not significantly correlated with FFR and demonstrated poor reproducibility.ConclusionAlthough myocardial ESL duration was significantly prolonged in patients with CAD compared with patients without CAD, ESL at rest showed poor reproducibility, and this new parameter did not predict FFR in patients with suspected CAD.

Percutaneous Unprotected Left Main Coronary Artery Interventions – Updated Results and Current Recommendations

2011 ◽  
Vol 6 (1) ◽  
pp. 44
Author(s):  
Alfonso Ielasi ◽  
Alaide Chieffo ◽  
◽  
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Current Evidence ◽  
Drug Eluting Stent ◽  
Left Main ◽  
European Guidelines ◽  
Artery Disease ◽  
Randomised Controlled

Current guidelines recommend coronary artery bypass grafting (CABG) as the treatment of choice for patients who have unprotected left main coronary artery disease (ULMCA). Several registries and two randomised controlled clinical trials have shown that hard end-points such as cardiac death, myocardial infarctions and cerebrovascular events are similar following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation compared with CABG. However, current American and European guidelines do not endorse PCI as an appropriate alternative to CABG for patients with ULMCA. In this article we review the current evidence on PCI with DES for ULMCA stenosis treatment and propose future directions in this evolving topic of great interest.

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