Chinese Guideline for Percutaneous Coronary Intervention in Patients with Left Main Bifurcation Disease

Abstract

The coronary left main (LM) artery is characterized by large caliber, length varying from <8 to >15 mm, and 2 large daughter vessels branching from it; it supplies blood to a large area (>75%) of the myocardium. LM bifurcation lesion is defined as the presence of atherosclerosis involving either or both of the 2 daughter vessels. Thus, the optimal strategy of revascularization for diseased LM has been an interesting research topic for a long time. With developments in percutaneous techniques, design, and materials of drug-eluting stents; intravascular imaging; new generation of antiplatelet medications; and particularly recent pooled evidence from randomized clinical trials comparing percutaneous coronary intervention with coronary artery bypass grafting, implantation of a drug-eluting stenting with or without other approved techniques is considered an important therapeutic approach for LM bifurcation lesions. Mirroring the anatomical complexity of the LM, stenting LM bifurcations is technically demanding, and intraprocedural complications can be catastrophic given the large amount of jeopardized myocardium. Therefore, the Chinese Society of Cardiology designed a writing committee with members from 3 working groups (ie, clinical research, intravascular imaging and physiology, and interventional cardiology) for the first time, to write a guideline on percutaneous treatment for LM bifurcation lesions, with view to improve the procedural quality and clinical outcomes. This guideline consists of introduction, anatomical description of the LM tree, risk stratification, strategies of revascularization, antiplatelet strategy, follow-up, and long-term management for patients with LM bifurcation lesions.