CABG is tretment of choice for left main and complex proximal LAD lesions. So most patients get CABG in these situations.
The hemodynamic effects of LIMA graft on native left coronary artery can be tremendous and some times deterimental.
- One of the consistent observation has been , the moment LIMA is bypasssed into distal LAD the antegrade flow through left main is reduced .This is still more significant if circumflex is also grafted .
- For inital few weeks there is competition between LIMA flow and LAD flow and invariably LIMA wins , and native leftmain or LAD flow regresses and many times closes totally.
- Some studies have observed accelerated left main and LAD atherosclerosis.
- The native LAD and leftmain could be a source for thrombi and atheromatous debri and these migrate distally and have potential to block the LIMA entry point into LAD
- The advantage of having a patent native left main and LAD is that if the LIMA graft occludes later on native circulation may assist.
Dr.S.Venkatesan MD 
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