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Percutaneous Left Main Coronary Intervention: A Review of Plaque Modification in Left Main Percutaneous Coronary Intervention

by Chirag A. Shah 1,* and Steven E. Pfau 1,2,*
1
Yale-New Haven Hospital, Yale School of Medicine, New Haven, CT 06510, USA
2
West Haven Veterans Administration Hospital, West Haven, CT 06516, USA
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(7), 180; https://doi.org/10.3390/jcm7070180
Received: 1 July 2018 / Revised: 19 July 2018 / Accepted: 20 July 2018 / Published: 23 July 2018
(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)
Left main coronary artery (LMCA) stenosis has long been recognized as a marker of increased morbidity and mortality. Current treatment algorithms for LMCA stenosis consider both percutaneous coronary intervention (PCI) with drug eluting stents (DES) and coronary bypass surgery, each with advantages based on individual patient characteristics. Since the LMCA is the largest artery in the coronary tree, plaque volume and calcification is greater than other coronary segments and often extends to the distal bifurcation segment. In LMCA bifurcation lesions, larger minimal stent area is strongly associated with better outcome in the DES era. Plaque modification strategies such as rotational, orbital, or laser atherectomy are effective mechanisms to reduce plaque volume and alter compliance, facilitating stent delivery and stent expansion. We present a case of a calcified, medina class 1,1,1 LMCA lesion where intravascular ultrasound (IVUS) and orbital atherectomy were employed for optimal results. In this context, we review the evidence of plaque modification devices and the rationale for their use in unprotected left main PCI. View Full-Text
Keywords: left main coronary artery; left main percutaneous coronary intervention; coronary artery bypass surgery; atherectomy; percutaneous coronary intervention left main coronary artery; left main percutaneous coronary intervention; coronary artery bypass surgery; atherectomy; percutaneous coronary intervention
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Shah, C.A.; Pfau, S.E. Percutaneous Left Main Coronary Intervention: A Review of Plaque Modification in Left Main Percutaneous Coronary Intervention. J. Clin. Med. 2018, 7, 180.

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