title: Interventional Management of Unprotected Left Main Coronary Artery Disease: Patient Selection and Technique Optimization.
abstract: For many years, coronary artery bypass graft surgery has been the gold standard for revascularization of patients with left main disease; however, increasing evidence suggests that percutaneous coronary intervention with drug-eluting stents may be an acceptable alternative or even preferred in select cases. This review will present clinical evidence examining the outcomes of drug-eluting stents compared to coronary artery bypass graft surgery for unprotected left main coronary artery disease and discuss the anatomic factors, patient variables, and clinical strategies that may dictate choice of revascularization modality for patients with left main disease. If percutaneous coronary intervention is selected to treat unprotected left main disease, meticulous technique is essential to optimize outcomes, including use of procedural physiology and imaging guidance, optimal stent and adjunct pharmacology use, and expert management of the distal bifurcation. Finally, issues of equipoise and uncertainty are identified, representing areas for future investigation.
authors.affiliation: The Scottsdale-Lincoln Health Network, Scottsdale Healthcare Hospitals, Scottsdale, Arizona.
authors.forename: David G
authors.initials: DG
authors.lastname: Rizik
authors.affiliation: The Scottsdale-Lincoln Health Network, Scottsdale Healthcare Hospitals, Scottsdale, Arizona.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Klassen
authors.affiliation: The Scottsdale-Lincoln Health Network, Scottsdale Healthcare Hospitals, Scottsdale, Arizona.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Burke
authors.affiliation: Case Western Reserve School of Medicine, MetroHealth Medical Center, Cleveland, Ohio.
authors.forename: John McB
authors.initials: JM
authors.lastname: Hodgson
authors.affiliation: Columbia University Medical Center, New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D054855:Drug-Eluting Stents; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D007423:Intra-Aortic Balloon Pumping; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors