Intravascular Ultrasound-Guided Percutaneous Coronary Intervention for Left Main Disease: Does Procedural Fine-Tuning Make a Relevant Clinical Benefit?

Abstract

Owing to the large area of jeopardized myocardium, left main coronary artery (LMCA) disease was associated with high morbidity and mortality and, thus, coronary artery bypass grafting has been the standard revascularization approach. However, over the several decades, there was a considerable evaluation in the field of percutaneous coronary intervention (PCI). Remarkable advancements in stent devices, technical refinement, and adjunctive medical therapy has led to improved PCI outcomes for unprotected LMCA disease.1 Especially, with a widespread use of drug-eluting stents, PCI for LMCA lesion has become technically more feasible and achieved favorable long-term clinical outcomes. Subsequently, several clinical trials using first-generation drug-eluting stents showed comparable rates of death and hard clinical end points after PCI and coronary artery bypass grafting.2–5 Recently, primary results of 2 large-sized trials adopting second-generation drug-eluting stents, EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic–Baltic–British Left Main Revascularization Study), were published.6,7 Although opposing findings may have an uncertainty on the optimal revascularization strategy, these trials also demonstrated how much PCI has been improved for LMCA treatment. See article by Andell et al Despite a marked advancement of stent device, many unresolved technical issues still remain, including how to optimize procedural results of left main intervention. For this purpose, accurate assessment of LMCA lesion is crucial …