title: Left main coronary artery stenosis: severity evaluation and implications for management.
abstract: The significant stenosis of the left main coronary artery is associated with poor outcomes and is considered a strong indication for revascularization. However, deciding whether the stenosis is significant can sometimes be challenging, especially when the degree of stenosis is intermediate, and can necessitate additional tests and imaging modalities. Areas covered: We did a literature search using keywords like 'left main', 'imaging', 'intravascular ultrasound', 'fractional flow reserve', 'computed tomographic angiography' and 'magnetic resonance imaging'. The most commonly used methods for better characterizing intermediate left main coronary stenoses are intravascular ultrasound and fractional flow reserve, while optical coherence tomography is the newer technique that provides better images, but for which not as much data is available. The noninvasive techniques are coronary computed tomographic angiography and, to a lesser degree, coronary magnetic resonance imaging. Expert commentary: Accurately determining the severity of left main coronary stenosis can mean the difference between a major intervention and conservative therapy. The reviewed newer imaging modalities give us greater confidence that patients with left main stenosis are assigned to the right treatment modality.
authors.affiliation: a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Habibi
authors.affiliation: a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA.
authors.forename: Rahman
authors.initials: R
authors.lastname: Shah
authors.affiliation: a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA.
authors.forename: Chalak O
authors.initials: CO
authors.lastname: Berzingi
authors.affiliation: a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Melchior
authors.affiliation: a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Sumption
authors.affiliation: a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA.
authors.forename: Ion S
authors.initials: IS
authors.lastname: Jovin
mesh_terms: D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence
keywords: Left main coronary; fractional flow reserve; intravascular ultrasound; optical coherence tomography; outcomes