Left Main Coronary Intervention: Current Practice and Emerging Paradigms

Left main coronary artery disease remains a critical factor in cardiovascular morbidity and mortality, historically treated with coronary artery bypass grafting (CABG). Advances in percutaneous coronary intervention (PCI), including improved stent technology, intravascular imaging, and procedural techniques, have established PCI as a viable alternative, especially in low-to-intermediate anatomical complexity. Randomized trials and meta-analysis demonstrate comparable mortality outcomes between PCI and CABG, but PCI carries higher repeat revascularization rates and spontaneous myocardial infarction. Contemporary left main (LM) PCI techniques include intravascular imaging, stepwise provisional stenting, drug-coated balloons, physiology-guided interventions, and optimal medical therapy to achieve comparable outcomes with CABG. A patient-centered, heart team-based approach is the need of the hour in left main (LM) intervention.