Left Main Stenosis - Where Do We Stand?

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Abstract

The presence of significant left main coronary disease is associated with increased mortality. Limited data examining the role of surgery in patients with a left main stenosis suggest a significant improvement in longevity. With the advent of coronary stenting, particularly the use of drug-eluting stents and improvements in percutaneous technology, left main coronary intervention has become more commonplace. However, despite important advances in the understanding of left main disease, management can be challenging. Many aspects, including the assessment of significance and the need for and choice of intervention (surgical or percutaneous revascularisation), remain unclear. This article serves to facilitate the management of patients with left main coronary disease with a focus on the assessment of lesion significance and the role of percutaneous intervention.

Disclosure
The authors have no conflicts of interest to declare.
Correspondence
Horst Sievert, CardioVascular Centre Frankfurt, Seckbacher Landstrasse 65, 60389 Frankfurt, Germany. E: info@CVCFrankfurt.de
Received date
30 May 2010
Accepted date
28 July 2010
DOI
http://dx.doi.org/10.15420/icr.2010.5.1.10
References
  1. Conley MJ, Ely RL, Kisslo, et al., Circulation, 1978;57(5): 947–52.
    Crossref | PubMed
  2. Proudfit WL, Shirey EK, Sones FM Jr, Circulation, 1967;36(1):54–62.
    Crossref | PubMed
  3. Cohen MV, Gorlin R, Circulation, 1975;52(2):275–85.
    Crossref | PubMed
  4. Boehrer JD, Lange RA, Willard JE, et al., Am J Cardiol, 199;70(18):1388–90.
    Crossref | PubMed
  5. Jansson K, Fransson SG, Clin Radiol, 1996;51(12):858–60.
    Crossref | PubMed
  6. Johnson LW, Lozner EC, Johnson S, et al., Cathet Cardiovasc Diagn, 1989;17(1):5–10.
    Crossref | PubMed
  7. DeMots H, Rösch J, McAnulty JH, et al., Cardiovasc Clin, 1977;8(2):201–11.
    PubMed
  8. Topaz O, Warner M, Lanter P, et al., Am Heart J, 1991;122(5):1308–14.
    Crossref | PubMed
  9. Miller GA, Honey, M, el-Sayed H, Cathet Cardiovasc Diagn, 1986;12(1):30–34.
    Crossref | PubMed
  10. Salem BI, Terasawa M, Mathur VS, et al., Cathet Cardiovasc Diagn, 1979;5(2):125–34.
    Crossref | PubMed
  11. Tommaso CL, Applefeld MM, Singleton RT, Am J Cardiol, 1988;61(13):111–20.
    Crossref | PubMed
  12. Welch CC, Proudfit WL, Sheldon WC, Am J Cardiol, 1975;5(2):211–15.
    Crossref | PubMed
  13. Yamanaka O, Hobbs RE, Jpn Circ J, 1993;57(5):404–10.
    Crossref | PubMed
  14. Lim JS, Proudfit WL, Sones FM Jr, Am J Cardiol, 1975;36(2):131–5.
    Crossref | PubMed
  15. CampeauL, Cobara F, Crochet D, et al., Circulation, 1978;57(6):1111–15.
    Crossref | PubMed
  16. Ricciardi MJ, Meyers S, Choi K, et al., Am Heart J, 2003;146(3):507–12.
    Crossref | PubMed
  17. Dalager-Pedersen S, Ravn HB, Falk E, Am J Cardiol, 1998;82(10B):37T–40T.
    Crossref | PubMed
  18. Davies MJ, Thomas A, N Engl J Med, 1984;310(18): 1137–40.
    Crossref | PubMed
  19. King SB 3rd, Smith SC Jr, Hirshfeld JW Jr, et al., J Am Coll Cardiol, 2008;51(2):172–209.
    Crossref | PubMed
  20. Smith SC Jr, Feldman TE, Hishfeld JW Jr, et al., Catheter Cardiovasc Interv, 2006;67(1):87–112.
    Crossref | PubMed
  21. Yusuf S, Zucker D, Peduzzi P, et al., Lancet, 1994;344(8922):563–70.
    Crossref | PubMed
  22. Takaro T, Hultgren HN, Lipton MJ, et al., Circulation, 1976;54(6 Suppl.):III107–17.
    PubMed
  23. European Coronary Surgery Study Group, Lancet, 1982;2(8309):1173–80.
    Crossref | PubMed
  24. Chaitman BR, Fisher LD, Bourassa MG, et al., Am J Cardiol, 1981;48(4):765–77.
    Crossref | PubMed
  25. Takaro T, Peduzzi P, Detre KM, et al., Circulation, 1982;66(1):14–22.
    Crossref | PubMed
  26. The VA Coronary Artery Bypass Surgery Cooperative Study Group, Circulation, 1992;86(1):21–30.
    Crossref | PubMed
  27. Caracciolo EA, Davis KB, Sopko G, et al., Circulation, 1995;91(9):2335–44.
    Crossref | PubMed
  28. Arnett EN, Isner JM, Redwood DR, et al., Ann Intern Med, 1979;91(3):350–56.
    Crossref | PubMed
  29. Fisher LD, Judkins MP, Lesperance J, et al., Cathet Cardiovasc Diagn, 1982;8(6):565–75.
    Crossref | PubMed
  30. Isner JM, Kishel J, Kent KM, et al., Circulation, 1981;63(5):1056–64.
    Crossref | PubMed
  31. Zir LM, Miller SW, Dinsmore RE, et al., Circulation, 1976;53(4):627–32.
    Crossref | PubMed
  32. Sanmarco ME, Brooks SH, Blankenhorn DH, Am Heart J, 1978;96(4):430–37.
    Crossref | PubMed
  33. Nissen SE Yock P, Circulation, 2001;103(4):604–16.
    Crossref | PubMed
  34. Jasti V, Ivan E, Yalamanchili V, et al., Circulation, 2004;110(18):2831–6.
    Crossref | PubMed
  35. Fassa AA, Wagatsuma K, Higano ST, et al., J Am Coll Cardiol, 2005;45(2):204–11.
    Crossref | PubMed
  36. Dodge JT Jr, Brown BG, Bolson EL, et al., Circulation, 1992;86(1):232–46.
    Crossref | PubMed
  37. James T, Anatomy of the Coronary Arteries, Hagerstown, MD, Harper Brothers, 1961:12–150.
  38. Suemaru S, Iwasaki K, Yamamoto K, et al., Heart Vessels, 2005;20(6):271–7.
    Crossref | PubMed
  39. Bech GJ, Droste H, Pijls NH, et al., Heart, 2001;86(5): 547–52.
    Crossref | PubMed
  40. Bergelson BA, Tommaso CL, Am Heart J, 1995;129(2): 350–59.
    Crossref | PubMed
  41. O’Keefe JH Jr, Hartzler GO, Rutherford BD, et al., Am J Cardiol, 1989;64(3):144–7.
    Crossref | PubMed
  42. Hartzler GO, Rutherford BD, McConahay DR, et al., Am J Cardiol, 1988;61(14):33G–37G.
    Crossref | PubMed
  43. Stertzer SH, Myler MK, Insel H, et al., Int J Cardiol, 1985;9(2):149–59.
    Crossref | PubMed
  44. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty), J Am Coll Cardiol, 1988;12(2):529–45.
    Crossref | PubMed
  45. Rozenman Y, Lotan C, Weiss AT, et al., Cathet Cardiovasc Diagn, 1995;36(1):63–6.
    Crossref | PubMed
  46. Ellis SG, Tamai H, Nobuyoshi M, et al., Circulation, 1997;96(11):3867–72.
    Crossref | PubMed
  47. Kornowski R, Klutstein M, Satler LF, et al., Am J Cardiol, 1998;82(1):32–7.
    Crossref | PubMed
  48. Nayak AK, Davis R Reddy HK, et al., South Med J, 2000;93(4):415–23.
    Crossref | PubMed
  49. Tsuchikane E, Aizawa T, Tamai H, et al., J Am Coll Cardiol, 2007;50(20):1941–5.
    Crossref | PubMed
  50. Park SJ, Hong MK, Lee CW, et al., J Am Coll Cardiol, 2001;38(4):1054–60.
    Crossref | PubMed
  51. Anzuini A, Rosanio S, Di Mario C, et al., Am J Med Sci, 2000;319(5):314–19.
    Crossref | PubMed
  52. Rekik S, Brunet J, Bayet G, et al., J Invasive Cardiol, 2010;22(5):231–4.
    PubMed
  53. Prasad SB, Malaiapan Y, Ahmar W, et al., Cardiovasc Revasc Med, 2009;10(2):136–9.
    Crossref | PubMed
  54. Serruys PW, de Jaegere P, Kiemeneij F, et al., N Engl J Med, 1994;331(8):489–95.
    Crossref | PubMed
  55. Fischman DL, Leon MB, Bain DS, et al., N Engl J Med, 1994;331(8):496–501.
    Crossref | PubMed
  56. Chauhan A, Zubaid M, Ricci DR, et al., Cathet Cardiovasc Diagn, 1997;41(1):21–9.
    Crossref | PubMed
  57. Kosuga K, Tamai H, Ueda K, et al., Am J Cardiol, 1999;83(1):32–7.
    Crossref | PubMed
  58. Laruelle CJ, Brueren GB, Ernst SM, et al., Heart, 1998;79(2):148–52.
    Crossref | PubMed
  59. Silvestri M, Barragan P, Sainsous J, et al., J Am Coll Cardiol, 2000;35(6):1543–50.
    Crossref | PubMed
  60. Karam C, Fajadet J, Cassagneau B et al., Am J Cardiol, 1998;82(8):975–8.
    Crossref | PubMed
  61. Lopez JJ, Ho KK, Stoker RC, et al., J Am Coll Cardiol, 1997;29(2):345–52.
    Crossref | PubMed
  62. Park SJ, Park SW, Hong MK, et al., J Am Coll Cardiol, 1998;31(1):37–42.
    Crossref | PubMed
  63. Tamburino C, Di Salvo ME, Capodanno D, et al., Am J Cardiol, 2009;103(2):187–93.
    Crossref | PubMed
  64. Erglis A, eNarbuee I, Kumsars I, et al., J Am Coll Cardiol, 2007;50(6):491–7.
    Crossref | PubMed
  65. Buszman PE, Kiesz SR, Bochnek A, et al., J Am Coll Cardiol, 2008;51(5):538–45.
    Crossref | PubMed
  66. Serruys PW, Morice MC, Kappetein AP, et al., N Engl J Med, 2009;360(10):961–72.
    Crossref | PubMed
  67. Serruys PW, TCT Meeting, Washington, DC, 2008.
  68. Chieffo A, Morici N, Maisano F, et al., Circulation, 2006;113(21):2542–27.
    Crossref | PubMed
  69. Lee MS, Kapoor N, Jamal F, et al., J Am Coll Cardiol, 2006;47(4):864–70.
    Crossref | PubMed
  70. Palmerini T, Marzocchi A, Marrozzini C, et al., Am J Cardiol, 2006;98(1):54–9.
    Crossref | PubMed
  71. Sanmartín M, Baz JA, Claro R, et al., Am J Cardiol, 2007;100(6):970–73.
    Crossref | PubMed
  72. Price MJ, Cristea E, Sawhney N, et al., J Am Coll Cardiol, 2006;47(4):871–7.
    Crossref | PubMed
  73. Chieffo A, Park SJ, Valgimigli M, et al., Circulation, 2007;116(2):156–62.
    Crossref | PubMed
  74. Seung KB, Park DW, Kim YH, et al., N Engl J Med, 2008;358(17):1781–92.
    Crossref | PubMed
  75. Biondi-Zoccai GG, Lotrionte M, Moretti C, et al., Am Heart J, 2008;155(2):274–83.
    Crossref | PubMed
  76. Taggart DP, Kaul S, Boden WE, et al., J Am Coll Cardiol, 2008;51(9):885–92.
    Crossref | PubMed
  77. Chieffo A, Park SJ, Meliga E, et al., Eur Heart J, 2008;29(17):2108–15.
    Crossref | PubMed
  78. Mehilli J, Kastrati A, Byrne RA, et al., J Am Coll Cardiol, 2009;53(19):1760–68.
    Crossref | PubMed
  79. Meliga E, Garcia-Garcia HM, Valgimigli M, et al., J Am Coll Cardiol, 2008;51(23):2212–19.
    Crossref | PubMed
  80. Kereiakes DJ, Faxon DP, Circulation, 2006;113(21):2480–84.
    Crossref | PubMed
  81. Sheiban I, Sillano D, Biondi-Zaccai G, et al., J Am Coll Cardiol, 2009;54(13):1131–16.
    Crossref | PubMed
  82. Valgimigli M, Malagutti P, Aoki J, et al., J Am Coll Cardiol, 2006;47(3):507–14.
    Crossref | PubMed
  83. Park SJ, Kim YH, Lee BK, et al., J Am Coll Cardiol, 2005;45(3):351–6.
    Crossref | PubMed
  84. Chieffo A, Stankovic G, Bonizzoni E, et al., Circulation, 2005;111(6):791–5.
    Crossref | PubMed
  85. Kim YH, Park SW, Hong MK, et al., Am J Cardiol, 2006;97(11):1597–1601.
    Crossref | PubMed
  86. Valgimigli M, Malagutti P, Rodriguez Granillo GA, et al., Am Heart J, 2006;152(5):896–902.
    Crossref | PubMed
  87. Valgimigli M, van Mieghem CA, Ong AT, et al., Circulation, 2005;111(11):1383–9.
    Crossref | PubMed