Left main coronary artery disease

Despite its short length, the left main coronary artery remains one of the most challenging areas of disease in interventional cardiology today. This challenge draws from the need for an accurate diagnosis as well as a changing management strategy. Since the consequences are significant, the use of intravascular ultrasound or fractional flow reserve should be considered when making the diagnosis, especially in cases of intermediate disease. Noninvasive imaging modalities such as cardiac computed tomography have high sensitivity and specificity for the left main coronary artery and will likely have an increasing surveillance role in the future, especially in ruling out disease. Although coronary artery bypass grafting remains the standard of care for the revascularization of this area, advances in interventional cardiology have improved outcomes in selected patients so that they are now comparable to coronary artery bypass grafting at least up to medium-term follow-up. Going forward the preferred revascula...