Review highlights current interventions for left main bifurcation, including drug-eluting stents

A review of studies by Dr. Tanveer Rab showed that percutaneous coronary intervention for left main coronary stenosis using 2nd-gen drug-eluting stents is safe and the outcomes are comparable to coronary artery bypass grafting. The group published their findings in JACC: Interventions and presented them at ACC 2017.

However, the team found that target lesion revascularization remains a problem.

For some patients, PCI is a safe alternative to coronary artery bypass grafting, according to results from the Excel and Noble studies. The researchers used these 2 studies to conduct a review and provide guidance on issues such as patient selection, risk scoring, intracoronary imaging, vessel preparation, and selection of stenting technique.

The group concluded that a single-stent provisional approach was the preferred strategy.

Larger stents and identification of diffuse left main disease are among the challenges for PCI of the left main bifurcation, the authors said. They also recommended a heart team approach for elective PCI and facilities that have intravascular ultrasound or optical coherence and the capacity to access coronary physiology.

The reviewers provided an algorithm for the management of left main bifurcation, as well as a variety of treatment options for left main disease.