Left main coronary artery disease


The left coronary artery, LCA and also known as the left main coronary artery (LMCA), is an artery that arises from the aorta above the left cusp of the aortic valve and feeds blood to the left side of the heart.

Usually runs for 1 to 25 mm and then bifurcates into the left anterior descending (LAD)) artery and the left circumflex artery (LCX).

Sometimes an additional artery arises at the bifurcation of the left main artery, forming a trifurcation; this extra artery is called the intermediate artery.

Arises from above the left portion of the aortic valve.

Travels in the inter-ventricular groove that runs in the anterior or front portion the heart, and sits between the right and the left ventricles or the two lower chambers of the heart.

Significant unprotected left main artery disease is defined as luminal narrowing of more than 50% without patent bypass grafts to its branches.

Unprotected left main disease occurs in 5-7% of patients undergoing coronary angiography.

Unprotected left main disease associated with a 3 year mortality without revascularization of 50%.

Coronary artery bypass surgery is considered as the gold standard treatment of unprotected left main coronary artery disease.

Improved stent technology and clinical experience explained the increased number of reports on the results of percutaneous coronary interventions (PCIs) for the treatment of left main (LM) coronary artery lesion.

Recent data comparing efficacy and safety of PCIs using drug-eluting stent and coronary artery bypass surgery showed comparable results in terms of safety and a lower need for repeat revascularization for coronary artery bypass surgery.

NOBLE trial randomized patients to PCI with Biolomus eluding stent or CABG: conclusion is that coronary artery bypass graft might be superior to PCI for the treatment of left main stem coronary artery disease.

In the EXCEL Trial patients with left main coronary artery disease of low or intermediate anatomical complexity treated with PCI or CABG there was no significant difference with respect to the rate of death, stroke, or myocardial infarction at five years.

In the above study estimates of all cause mortality and stroke were the same but there was significantly fewer clinically apparent and fewer repeat vascularization procedures with CABG.

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