Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery.
For coronary artery disease with unprotected left main stem (LMS) stenosis, coronary artery bypass grafting (CABG) is traditionally regarded as the "standard of care" because of its well-documented and durable survival advantage. There is now an increasing trend to use drug-eluting stents for LMS stenosis rather than CABG despite very little high-quality data to inform clinical practice. We herein: 1) evaluate the current evidence in support of the use of percutaneous revascularization for unprotected LMS; 2) assess the underlying justification for randomized controlled trials of stenting versus surgery for unprotected LMS; and 3) examine the optimum approach to informed consent. We conclude that CABG should indeed remain the preferred revascularization treatment in good surgical candidates with unprotected LMS stenosis.
Taggart
David P
DP
Department of Cardiac Surgery, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. david.taggart@orh.nhs.uk
Kaul
Sanjay
S
Boden
William E
WE
Ferguson
T Bruce
TB
Guyton
Robert A
RA
Mack
Michael J
MJ
Sergeant
Paul T
PT
Shemin
Richard J
RJ
Smith
Peter K
PK
Yusuf
Salim
S
D032962:Consent Forms; D001026:Coronary Artery Bypass / Q000009:adverse effects; D023903:Coronary Restenosis / Q000209:etiology*; D023921:Coronary Stenosis / Q000601:surgery / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D006801:Humans; D016896:Treatment Outcome