Left main disease is the most dangerous subset of CAD population .The danger is attributable more on the perceived fear of sudden occlusion .How often this occurs in stable , left main plaques is not known.
There is a significant group of patients with isolated , asymptomatic , non flow limiting , leftmain disease with stable , smooth plaques. The ideal management for this group of CAD is not clear.
Advising a CABG /PCI is an easy and very practical decision ! That’s what the current guideline also suggest
But is there scientific evidence to do that ? Many times practical approach could be synonymous with an unscientific approach.
- PCI has a potential to convert a stable plaque into a vulnerable one (Metalled plaque is not inert )
- CABG will reduce the flow across , the already narrowed left main and there is a likely hood of rapid progression of native left main disease
So what is left ?
If it is a stable plaque , and does not limit the flow both at rest on exercise * medical management will be optimal.
* Excercise stress test must be done
Read this article from the circulation , that suggests a role for medical management for left main disease
Dr.S.Venkatesan MD 