State-of-the-art percutaneous coronary intervention for left main coronary artery disease in Japan.
Takayuki WarisawaShinjo SonodaKyohei YamajiTetsuya AmanoShun KohsakaMasahiro NatsuakiKenichi TsujitaKiyoshi HibiYoshio KobayashiKen KozumaPublished in: Cardiovascular intervention and therapeutics (2024)
Percutaneous coronary intervention for left main coronary artery disease (LM-PCI) represents a high-risk yet life-saving procedure that has evolved significantly over the years. This review outlines the current state-of-the-art practices for LM-PCI in Japan in detail, emphasizing the integration of coronary physiology and intracoronary imaging alongside with evidence-based standardized technique using latest drug-eluting stents. These advancements enable precise lesion assessment, stent sizing, and optimal deployment, thereby enhancing procedural safety and efficacy. Despite discrepancies between current guidelines favoring coronary artery bypass grafting and real-world practice trends towards increased LM-PCI adoption, particularly in elderly populations with multiple comorbidities, careful patient selection and procedural planning are critical. Future perspectives include further refining LM-PCI through conducting randomized controlled trials integrating advanced techniques and addressing the issue of ostial left circumflex lesions and nationwide standardization of medical care for LM disease.
Keyphrases
- coronary artery disease
- percutaneous coronary intervention
- coronary artery bypass grafting
- st elevation myocardial infarction
- st segment elevation myocardial infarction
- acute myocardial infarction
- antiplatelet therapy
- cardiovascular events
- acute coronary syndrome
- primary care
- healthcare
- randomized controlled trial
- aortic stenosis
- coronary artery bypass
- quality improvement
- case report
- minimally invasive
- emergency department
- systematic review
- left ventricular
- mass spectrometry
- cross sectional
- clinical trial
- coronary artery
- heart failure
- atrial fibrillation
- transcatheter aortic valve replacement