Left main stenting

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  • Detection of obstructive disease of the left main coronary artery (LMCA) is relatively unusual in the catheterisation laboratory, as it accounts for approximately 4% of all coronary angiograms, with isolated LMCA disease observed in only 5–10% of these cases.

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    Detection of obstructive disease of the left main coronary artery (LMCA) is relatively unusual in the catheterisation laboratory, as it accounts for approximately 4% of all coronary angiograms, with isolated LMCA disease observed in only 5–10% of these cases.

    Intervention to the LMCA is notable compared to the treatment of coronary stenosis elsewhere in the coronary tree. Potential complications occurring during LMCA intervention may rapidly progress towards haemodynamic instability, since the LMCA provides the blood supply to 80% of the left ventricle in patients with right coronary dominance. LMCA disease is difficult to assess angiographically because of the possible lack of a proximal reference. Atherosclerosis at the LMCA site is diffuse in many cases, frequently involving bifurcation, and often features a higher rate of fibrotic and calcific components, making LMCA lesions tougher with a consequent need for appropriate and careful lesion preparation.

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