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Nov 04

LEFT MAIN STENOSIS : NEED TO RESTART THE DEBATE IN 2011

By A. B. Mehta, Nihar Mehta

In the modern era of Drug eluting stents (DES), percutaneous coronary intervention (PCI) has emerged as a suitable option to coronary artery bypass graft surgery (CABG) in the majority of patients of left main stenosis (LMS).

PCI with DES is a better choice in patients with ostial and mid shaft left main stenosis and in the distal bifurcation left main stenosis requiring only one stent.  CABG is suitable for patients of left main stenosis with distal bifurcation lesions requiring more than one stent or with triple vessel disease.

However, certain unfavourable aspects of CABG should be taken into account such as the sub-optimal patency rates of non-LIMA bypass grafts, the severe native vessel disease acceleration after CABG and the unquantifiable morbidity associated with CABG.

Hence the trend is definitely shifting towards PCI for left main stenosis.

[In CSI cardiology Update …… in print]

 

 

 

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