Left Main Stem Disease Treatment

Early attempts by interventional cardiologists to treat lms disease with balloon angioplasty and bare metal stents resulted in unacceptably high rates of restenosis and mortality and as a result the initial enthusiasm for percutaneous approaches waned.

Left main stem disease treatment. Coronary artery bypass grafting cabg versus percutaneous coronary intervention pci with the use of a drug releasing stent. For example isolated lmca lesions involving the ostium or shaft do well with either percutaneous coronary intervention pci or coronary artery bypass graft surgery cabg. Coronary artery bypass surgery has been the definitive treatment choice. Treatment of left main disease.

Many studies have reported survival benefits of coronary artery bypass grafting cabg compared to medical treatment alone in lms stenosis and cabg has been regarded as the gold standard for the treatment of left main coronary artery disease. Please explain about mild diseases of proximal lad also advise about the dietary modifications required in these conditions. A mild disease in lad means that the left anterior descending artery which is one of the 3 arteries supplying blood to a very important area of the heart anterior wall and the interventricular septum has fatty deposits in the wall at a point which is not. Left main disease is the blockage of the left main coronary artery.

L eft main stem atherosclerotic disease which supplies the vast portion of the left ventricle myocardium is associated with significant morbidity and mortality. Left main stem pathology is often silent with unpredictable presentation. However distal lm bifurcation lesions or those associated with complex multivessel disease may do better with surgical revascularization. Left main coronary artery lmca disease remains an important risk factor for increased mortality and morbidity at all stages of diagnosis and treatment of coronary artery disease.

Lms disease became synonymous with surgical disease and mandated a referral for cabg. A coronary artery bypass graft cabg is a surgical procedure used to treat coronary heart disease. They provided extensive guidance for patients with left main stem disease. A meta analysis of the seven major studies conducted between 1972 1984 by yusuf et al showed a 68 reduction in mortality at 5 years in patients who underwent cabg compared to medical therapy for left main disease.

An effective left internal mammary to left anterior descending coronary artery bypass reproducibly provides excellent long term outcomes and as most surgeons have more experience with bypass grafting this approach is widely favoured over surgical angioplasty of the lmca for isolated left main stem disease. This study aims to compare two treatments. As such it poses diagnostic and management challenges.