We do know about left main equivalent . Do we have a proximal LAD equivalent ?
Proximal LAD lesions deserve a special attention and probably urgent intervention. Medical management is not an option in most patients. (Proximal alone is not suffice , it should be critical as well )
But we have another issue on hand .What really is proximal LAD ? .
- First 5 Cm of LAD ? (LAD normally measure about 15cm so 1/3rd becomes proximal .How logical it looks isn’t ? )
- Before any S1 or D1 ?
- Before any major S1 or D1 ?
- Septal branch is not considered at all . A lesion is said to be proximal if it is before a major D1
- Some others may argue if there are three major branch distal to lesion it should be considered proximal.
Proximal LAD equivalents .
LAD first or second bifurcation lesions ( Medina1 1 1 , 1 1 0 , 1 0 1)
Mid LAD lesion with major D1 ostial lesions
For a super-dominant LAD even mid segment lesion can be a proximal equivalent (By area at jeopardy )
If LAD is giving collaterals to LCX /OM / due to associated lesions , LAD lesion at any level becomes a left main equivalent .