Left Main Coronary Artery Stenosis: Stenting Techniques And The Role Of Intravascular Imaging

Abstract

Left main coronary artery (LMCA) stenosis is a particularly important form of coronary artery disease due to the fact that it supplies a large proportion of the left ventricular myocardium. Although coronary artery bypass grafting (CABG) remains an important treatment option, percutaneous coronary intervention (PCI) is becoming an effective alternative. The choice between CABG and PCI depends on the patient's clinical characteristics, anatomical complexity, and the extent of the coronary artery disease. In distal LMCA bifurcation lesions, selecting the appropriate stenting technique is essential, with provisional stenting generally preferred for simpler lesions and two stent techniques having advantages in selected complex bifurcations. Intravascular imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) plays an essential role in assessing lesion severity, guiding stent implantation, and optimizing the final procedural result. Ultimately, successful LMCA intervention depends not on a single superior technique, but on individualized treatment selection, appropriate procedural execution, and imaging guided optimization.