Arun Kanmanthareddy1, Dixitha Anugula2, Biswajit Kar3,4. 1. Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, 6431 Fannin Street, MSB 1.240 A, Houston, TX, 77030, USA. akanmantha@gmail.com. 2. Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA. 3. Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, 6431 Fannin Street, MSB 1.240 A, Houston, TX, 77030, USA. 4. Center for Advanced Heart Failure, Memorial Hermann Heart and Vascular Institute, Houston, TX, USA.
Abstract
PURPOSE OF REVIEW: This review was performed with the goal of summarizing the role of operator experience in the treatment of severe left main stenosis by percutaneous intervention techniques. RECENT FINDINGS: The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial demonstrated that percutaneous coronary intervention and coronary artery bypass grafting had similar clinical outcomes for severe left main disease. However, PCI of the left main coronary stenosis is considered to be a high-risk intervention because of the large area of myocardium at jeopardy that can quickly cause hemodynamic compromise. Operator experience and familiarity with the use of hemodynamic support devices, plaque modification techniques, and intravascular imaging tools is associated with better clinical outcomes. In patients with severe left main stenosis undergoing percutaneous coronary intervention by high-volume operators, the clinical outcomes are superior.
PURPOSE OF REVIEW: This review was performed with the goal of summarizing the role of operator experience in the treatment of severe left main stenosis by percutaneous intervention techniques. RECENT FINDINGS: The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial demonstrated that percutaneous coronary intervention and coronary artery bypass grafting had similar clinical outcomes for severe left main disease. However, PCI of the left main coronary stenosis is considered to be a high-risk intervention because of the large area of myocardium at jeopardy that can quickly cause hemodynamic compromise. Operator experience and familiarity with the use of hemodynamic support devices, plaque modification techniques, and intravascular imaging tools is associated with better clinical outcomes. In patients with severe left main stenosis undergoing percutaneous coronary intervention by high-volume operators, the clinical outcomes are superior.
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