Left Main Stem Disease Definition

Atherosclerotic involvement of the left main stem was first described more than 100 years ago by herrick.

Left main stem disease definition. Traditionally cardiologist have a fear to touch this lesion as they thought a sudden occlusion within this vessel is life threatening. An effective left internal mammary to left anterior descending coronary artery bypass reproducibly provides excellent long term outcomes and as most surgeons have more experience with bypass grafting this approach is widely favoured over surgical angioplasty of the lmca for isolated left main stem disease. The left coronary artery abbreviated lca is an artery that arises from the aorta above the left cusp of the aortic valve and feeds blood to the left side of the heart it is also known as the left main coronary artery abbreviated lmca and the left main stem coronary artery abbreviated lms it is one of the coronary arteries. Later on as they gained experience it was thought we could intervene safely.

Left main disease is an important subset of cad and it has special interest for the interventionist. They compared 1888 patients who underwent cabg for left main stenosis with 8759 patients who had cabg for coronary disease without left main disease. Left main diseases usually have extensive coronary artery disease cad and the coexisting disease is often complex. The clinical angiographic exercise testing operative and follow up data of 26 patients found at angiography to have left main stem coronary artery stenosis defined as a reduction in the lumen diameter of 50 or more are reviewed.

Obstructive atheroma of the left main stem lms is relatively unusual as it is present in only 4 of diagnostic coronary angiograms 1 historically disease of the lms has been treated with particular respect as the lms provides blood supply to at least two thirds of the left ventricle 2 since prognosis after diagnosis of lms obstruction is poor without treatment and because. Significant left main stem lms stenosis is amongst the most feared findings during work up of suspected coronary artery disease. 1 with the adoption of coronary angiography as a routine diagnostic tool during the 1960s left main stem disease became increasingly recognized and patients with this condition were soon identified as a high risk group. The results of surgery of left main stenosis were reviewed by jonsson.

A significant stenosis 50 of the left main is present in 4 to 6 of patients who have undergone coronary angiography. During 1970 1984 early mortality was 5 8 in patients with left main stenosis vs1 5 in patients without left main stenosis. 2 in fact during this early era performing coronary. If there is no patent bypass graft to the left anterior descending lad or circumflex artery the disease is then referred to as unprotected left main disease uplm.