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Unprotected left main disease in 2011

  • The spectrum of left main disease, presented by A Chieffo (Milan, IT) - Slides
  • Rationale for surgery, presented by J R Pepper (London, GB) - Slides
  • Rationale for percutaneous revascularisation, presented by M C Morice (Massy, FR) - Slides
  • Future perspectives, presented by P W Serruys (Rotterdam, NL) - Slides

This interesting main session on the diagnosis and optimal management of unprotected left main disease was held on Sunday evening and simultaneously broadcasted on the internet. Significant left main disease is a cricital clinical conditions that requires prompt diagnosis and treatment as medical therapy only is not sufficient. Indeed, revascularisation of critical left main disease improves prognosis.

The spectrum of left main disease

The first speaker, Dr. A. Chieffo from Milan has published several papers on percutaneous revascularisation. Her role was to highlight the clinical spectrum of left main disease. Left main disease can be found in up to 5% of diagnostic angiograms. The anatomic distribution of left main disease is as follows : mostly (70% to 80% of cases) significant distal left main stem disease (with or without involvement of the left anterior descending or circumflex artery), less frequent (30% to 20%) ostial or mid shaft disease. Already during this lecture it was stressed that distal left main stenting is more complex and carries a slightly higher risk of adverse outcome. Dr. Chieffo also clearly demonstrated that drug eluting stents have revolutionized the technique of left main intervention by reducing the restenosis risk.

Rationale for surgery

Dr. Pepper, a cardiothoracic surgeon from London, gave the point of view of the cardiac surgeon. He insisted on the fact that surgery is the still the gold standard in terms of revascularization strategy with excellent clinical short and long-term results. He based his arguments on a historical overview of literature data argueing that even with current drug eluting stents, surgery still turns out better.

Rationale for percutaneous revascularisation

Dr. Morice from France discussed the rationale for percutaneous revascularization. Improved technique and modern second generation drug eluting stents have increased the safety of this intervention even in so-called high risk patients according to Dr. Morice.

Future perspectives

Finally, Prof. Serruys gave insights into future directions. He showed impressive images of CT-guided non invasive FFR measurements of the coronary arteries and in particular of the left main. This new technology would allow non-invasive diagnosis of the haemodynamic significance of coronary artery disease. He also gave insights into the recently started EXCEL trial. This will be a large randomized controlled trial comparing surgery and stenting with the Xience V stent for left main disease. Finally, he argued that dedicated stents for the left main stem bifurcation will certainly point at the horizon at a certain stage.




Unprotected left main disease in 2011

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.