How to optimize left main percutaneous coronary intervention.

Despite unfavorable outcomes in the early era of LMCA percutaneous coronary intervention (PCI), interventionalists have continued attempting percutaneous treatment for LMCA stenosis (3). Technical advances in PCI and stent technology, particularly with the widespread availability of drug-eluting stents (DES), have led physicians to re-evaluate the role of PCI as a viable alternative treatment for unprotected LMCA disease. As a result, during the last decade, the prevalence of LMCA stenting has significantly increased worldwide. In addition, several recent large registries and randomized controlled trials such as the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry, SYNTAX (SYNergy Between PCI With TAXUS and Cardiac Surgery), and PRECOMBAT (PREmier of Randomized COMparison of Bypass Surgery Versus AngioplasTy Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) randomized trials have demonstrated that LMCA stenting yields comparable mortality and morbidity rates to CABG (4–6). Currently, the PCI guideline for the elective treatment of LMCA stenosis