Left main stem disease: percutaneous coronary intervention vs. coronary artery bypass grafting—what about medical management? A case report

Optimal strategy for treating bifurcation lesions in the left main coronary artery (LMCA) remains elusive.

We describe a 66-year-old Caucasian male with a risk factor for coronary artery disease, but free of angina, who presented to the hospital after syncope and nsVT diagnosis in the 24 h Holter electrocardiography monitoring. Coronary computed tomography angiography revealed LMCA bifurcation stenosis with concomitant left circumflex artery (LCx) and diagonal branch stenosis. Subsequent coronary angiography confirmed diagnosis. Successful percutaneous coronary intervention (PCI) of bifurcation/distal LMCA disease involving ostium of LAD and LCx has been a challenging procedure.

Current guidelines still favour coronary artery bypass grafting (CABG) over PCI for revascularization in LMCA stenosis. However, great progress has been made on PCI; therefore, it has become the compelling alternative procedure to CABG for the LMCA bifurcation stenosis in appropriately selected patients.