The EBC MAIN LM study randomized 467 patients with severe left main coronary artery (LCA) lesions to receive provisional stenting or a two-sent strategy (Resolute or Onix stent). The two-stent strategy was decided by the operator (culotte, DK-minicrush, T/TAP). The crossover rate from those randomized to provisional stenting was 22%. After a 3-year follow-up, the composite...
Technique advancements in left main coronary artery angioplasty have turned this procedure into a reasonable alternative to surgery, particularly in patients with a low or intermediate Syntax score and, obviously, those in whom surgery was contraindicated. Results can be credited to a refinement in technique, better drug-eluting stents, better patient selection, and frequent use of...
Courtesy of Dr. Carlos Fava. Unprotected left main coronary artery angioplasty with drug-eluting stents has emerged as an acceptable strategy for a select group of patients, with results comparable to those of myocardial revascularization surgery at 2 or 3 years. However, beyond such term, we had no valid information. Researchers analyzed the 5-year follow-up results for the...
Courtesy of Dr. Carlos Fava. Around 5% of patients undergoing coronary angiography present severe left main coronary artery (LMCA) lesions. Myocardial revascularization surgery (MRS) is the preferred method for this group, although there is evidence from different randomized trials demonstrating the safety and efficacy of unprotected LMCA angioplasty, with results similar to those obtained through the traditional strategy....
Courtesy of Dr. Carlos Fava. Left main coronary artery (LMCA) lesions have always been defined as high-risk, with surgery as treatment of choice. Drug-eluting stents (DES) have slowly changed that, but their use still lacks strong supporting evidence. The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) study...
According to this new meta-analysis (presented at AHA 2021 and published in The Lancet), mortality is similar between surgery and angioplasty to treat left main coronary artery in patients with simple or intermediate anatomy. This new study estimates that, after 5 years, mortality with surgery would be 11.2% vs. 10.2% with angioplasty, a non-significant difference. This debate...
After 10 years of follow-up, there were no significant differences in the rates of major adverse cardiovascular or cerebrovascular events among patients with left main coronary artery disease randomized to angioplasty or surgery. Since this was the first study to randomize patients with left main coronary artery disease to angioplasty or surgery, it enrolled very few...
According to the EXCEL trial, peri-procedural infarction was more common after left main coronary artery surgery compared with angioplasty, and it was strongly associated with increased 3-year mortality after controlling all possible confounding variables. This increased mortality was only present in extensive infarctions with an increase in CK-MB ≥10×. The EXCEL trial seems to want...
Several studies (some of them recent, some of them not so much so) have compared left main coronary artery angioplasty and myocardial revascularization surgery. Combined, these works compose a large corpus of evidence, but follow-up has not gone beyond 5 years in any case. The main aim of this study (presented at TCT 2018 and published simultaneously...
Courtesy of Dr. Carlos Fava. Severe left main coronary artery (LMCA) lesions have a bad prognosis in coronary disease. In that scenario, current guidelines recommend surgery as the treatment of choice. However, due to the current development of second-generation drug-eluting stents (DES) and greater operator expertise, left main coronary artery angioplasty appears as a valid alternative...