The invasive intracoronary imaging assessment of left main coronary artery disease.

Abstract

Left main coronary artery disease is associated with an unfavorable prognosis. Evidence-based decision making regardingthe optimal revascularization strategy in patients with left main disease has become a challenge, in view of the recentlypublished data. An improvement in outcomes following left main percutaneous interventions could be achieved by reducingthe rate of repeat target lesion revascularization through stent optimization techniques. In the setting of left main disease, proceduralguidance by intravascular ultrasound or optical coherence tomography is essential for good long-term results, in sucha way that intravascular imaging has gained more of a therapeutic connotation. Besides stent optimization, intracoronary imagingquantifies lesion severity, guides lesion preparation through morphological data, facilitates stent selection through accuratevessel sizing, identifies the landing zones, diagnoses acute vessel wall complications such as stent-related edge dissection orintramural hematoma, and defines procedural success.This review focuses on the two main intracoronary imaging techniques used for diagnostic evaluation and proceduralguidance in left main coronary artery disease: intravascular ultrasound and optical coherence tomography. Based on the mostrecently published data, the review discusses each technique's advantages and pitfalls, and summarizes their indications.