Does unprotected left main-stem stenting have a role in current interventional practice?
Left main-stem disease is found in up to 5% of patients undergoing coronary angiography. Until recently, it has been regarded as an absolute indication for coronary bypass surgery, given the poor results of the early trials of balloon angioplasty for this condition. However, with rapidly advancing technology, including new generation stents and increasingly effective post-stenting anti-thrombotic regimens, there is now an increasing body of evidence to support the consideration of a percutaneous approach to left main-stem disease. Discerning patient selection, meticulous stent sizing and deployment, the routine use of intravascular ultrasound, aggressive anti-platelet regimes, and careful patient follow up are a few of the technical considerations required for a successful long-term outcome in this group.