Left Main Stenting for Unprotected Left Main Coronary Artery Disease

The left main coronary artery supplies blood to the heart's left ventricle. If that artery becomes blocked, surgeons have traditionally employed procedures such as a Coronary Artery Bypass Graft (CABG) to create a detour around the blockage, restoring blood flow.

However, patients with advanced coronary artery disease who have not undergone such procedures are said to have "unprotected" left main (ULM) disease, and may be candidates for a type of percutaneous coronary intervention (PCI) called left main stenting. This PCI procedure to treat ULM places a drug-eluting stent (a metal stent coated with a time-release medication) in the artery to open the blockage. Pioneered by Samin Sharma, MD, this minimally-invasive technique can lower the risk of complications, shorten hospital stays, and speed recovery when compared with CABG surgery.

Determining When Left Main Stenting is the Best Option

Left main coronary artery (LMCA) stenting (or PCI for ULM) is most often indicated for patients who are high risk for surgical complications or have comorbidities. Patients with advanced aortic calcification, low life expectancy, chronic obstructive pulmonary disease (COPD), or cerebrovascular disease may also be better suited for this PCI procedure than bypass surgery.

When choosing between a PCI procedure and CABG surgery, physicians will also take into consideration the patient's SYNTAX score, which is a grading tool for determining the complexity of coronary artery disease. For example, patients with a lower SYNTAX score are more likely to be candidates for PCI for ULM.

While left main stenting carries the benefits of being a minimally-invasive procedure requiring a shorter hospitalization than CABG, it is important for each patient to talk with their doctor to select the procedure that will be most effective for their particular case.

Left Main Stenting at Mount Sinai

The Mount Sinai Cath Lab has been identified as a center of excellence for ULM interventions, performing as many as 180 PCI's for ULM annually. Many of our patients have even been able to return home the same day as the procedure. Our interventionalists are skilled in determining when left main stenting is the best choice and performing the procedure with the safest and most successful possible outcomes.