Left Main Coronary Artery Stenting – Is it a Safe Approach?

Common coronary heart disease (CHD) also to referred as ischemic heart disease is the leading cause of heart attacks and angina. Atherosclerotic plaque build-up in the inner walls of coronary arteries hardens the blood vessels and restricts the blood supply to heart. Lack of oxygen leads to the damage or death of heart tissues which results in ischemia. Clots in the arteries can be life-threatening, as it eventually restricts or completely cuts off the oxygen-rich blood supply resulting in angina or myocardial infarctions (heart attacks). Some of the common coronary heart disease symptoms include sharp pain or pressure in the chest that travels to the arms and jaw, shortness of breath, light-headedness and fatigue. Even if the symptoms are mild, seeking immediate medical attention is necessary.

The left main coronary artery (LMCA) is responsible for supplying blood to a large segment of the myocardium and stenosis of LMCA will lead to acute cardiac events. Coronary Artery Bypass Graft (CABG) has been considered the standard therapeutic option for treating left main coronary artery disease (LMD), because it provides better survival rates when compared to drug therapy. Percutaneous coronary intervention (PCI) with bare metal stents tended to result in in-stent restenosis and a need for revascularization, making it a risky choice. But with the advent of state-of-the-art catheterization technologies, drug-eluting stents and antithrombotic agents, newer left main coronary artery stenting has made it a viable option for patients with high surgical risks or co-morbidities.

Ongoing clinical trials and research studies have been evaluating the effectiveness of using drug-eluting stents (DES) for Unprotected LMCA compared with CABG. Targeted lesion revascularization advantages of minimally invasive newer left main coronary artery stenting can be considered as a safe and effective alternative to CABG, especially for patients in a high-risk group. Even though DES is considered as a great step in interventional cardiology, concerns over the polymer-associated complications and risk of thrombosis have raised questions about its safety. Drug-eluting stent thrombosis is closely associated with acute myocardial infarction resulting in mortality and morbidity. Biocompatible and bioabsorbable stents that are developed in order to overcome issues such as drug-eluting stent thrombosis is a recent development in the interventional community that offers a promising approach for PCI in treating left main coronary artery disease. But in the meantime, cardiologists have to choose either PCI or CABG to manage the left main disease based on the SYNTAX score and medical-surgical consultation. 

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