Left Main Coronary Artery Disease

Since the early days of A. Gruntzig, most interven-tional cardiologists have considered percutaneous transluminal coronary angiography (PTCA) of unprotected left main stem lesions to be contraindicated because of the almost inevitable fatality when the procedure fails. In a series of 129 patients undergoing PTCA of unprotected left main stenoses, the procedural and 3-year mortality rates were 9.1% and 65%, respectively, with a need for subsequent revascular-ization in 42%.73 Because CABG was established as a therapy that reduces mortality compared with lone medical treatment, plain PTCA was completely abandoned.

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