CC BY-NC-ND 4.0 · Ind J Car Dis Wom 2018; 03(01): 049-060
DOI: 10.1055/s-0038-1668607
Interventional Rounds
Women in Cardiology and Related Sciences

Interventions for Left Main Coronary Artery Disease

Sujatha Vipperla
1  Department of Cardiology, Indus Hospitals, Affiliated to CSI India, SCAI, Visakhaptnam, Andhra Pradesh, India
› Author Affiliations
Further Information

Publication History

Publication Date:
31 August 2018 (online)

Introduction

Unprotected left main coronary artery (ULMCA) disease constitutes 5 to 7% of the patients undergoing coronary angiography.[1] It is associated with a high mortality as it supplies a large area of the myocardium—approximately 84% of the left ventricle in right dominant system and 100% in a left dominant system.[2] In CASS (Coronary Artery Surgery Study) registry, mortality in medically treated patients is as high as 63% at 5 years.[3]

Coronary artery bypass surgery (CABG) has been the standard management for patients with ULMCA disease. Percutaneous coronary intervention (PCI) has emerged as an attractive alternative to CABGs with the advent of drug-eluting stents (DES), development of antiplatelet pharmacology, and adjunctive imaging techniques.

Atherosclerotic plaque in left main coronary artery (LMCA) is qualitatively different from other segments of the coronary tree, with minimal necrotic core and less thin cap fibro atheroma.[4] Seventy percent of significant left main (LM) lesions involve the bifurcation. Intimal atherosclerosis is located in areas of low shear stress along the lateral wall extending distally on the lateral walls of the left anterior descending (LAD) and left circumflex (LCX) arteries. Involvement of flow divider (carina) is minimal or absent. Plaque extending into the proximal LAD, LCX, or both may be seen in 90, 66.4, and 62%, respectively.