It has become fashionable for many current generation cardiologists to stent the LAD with proximal end liberally extending into left main shaft in Medina 0, 1, 0 or (1,1,1 )lesions involving distal left main often jailing the LCX . This concept came into vogue as it helped bail out few hemo-dynamically unstable patients with true left main bifurcation lesions during primary PCI .Of course , it’s potentially useful strategy in emergency , if extended into routine situations (like all stable proximal LAD/Bifurcation ) we are bound to create few problems.
Rapidly protecting the left main with a long single stent down into LAD is an easy way out for tackling distal left main /LAD combined lesions. Conceptually it asks you to forget the LCX outright.(Coronary outrage for some to call LCX as a side branch of left main ! ).Of course, one can reconstruct the LCX ostium by other means or a second stent if required.
Final message
Conquering left main disease with a long stent right from its origin or mid shaft to LAD (Some times from Aortic ostium ! ) may be an interventional pride for the cardiologist. But , in no way it imply we have crossed the final frontier in LM disease.In fact, putting a left main coil is the easiest task among all PCI since there is little expertise required to cross the lesion .Maintaining its patency medium long run and thus beating the CABG is true achievement ! Achieving an acute patency of left main and wheeling out the patient live from cath lab can not be reason for permanent rejoice ! One should realise his life is at the mercy of DAPT and its pharmakinetics which we know can be unpredictable !
“Protecting the patient is more important than a protecting left main”
Just because a technique is easy to accomplish it doesn’t confer the right to misuse it .The argument “my patient” is doing fine with this type of stenting is not an appropriate way of justification.
Dr.S.Venkatesan MD 