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Purpose of Review <p>Evaluation of the left main [LM] stenosis by coronary angiography alone is limited by the lack of a reference segment, lesion angulation, eccentricity, bifurcation anatomy, overlapping branches, and foreshortening. We review the role of intravascular imaging with either intravascular ultrasound (IVUS) or optical coherence tomography [OCT] for procedural guidance and importantly to optimize LM percutaneous coronary intervention [PCI] outcomes.</p> Recent Findings <p>Contemporary data regarding routine imaging-guided LM-PCI is discordant with small randomized trials and observational studies showing favorable rate of target lesion revascularization and cardiac death with contemporaneous larger trials failing to show such benefit with routine intravascular imaging for LM PCI.</p> Summary <p>Available data does not support routine intravascular imaging in all patients undergoing LM PCI but could possibly benefit less experienced operators and in the setting of complex two stent LM PCI strategies. Selective use of intravascular imaging in patients undergoing LM PCI is supported by contemporary data.</p>

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Intravascular Imaging for Left Main Coronary Artery Disease

  • 期刊论文

  • 发表日期：

    2026年7月27日

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  • Shalini Mani,
  • Debabrata Mukherjee

摘要

Purpose of Review

Evaluation of the left main [LM] stenosis by coronary angiography alone is limited by the lack of a reference segment, lesion angulation, eccentricity, bifurcation anatomy, overlapping branches, and foreshortening. We review the role of intravascular imaging with either intravascular ultrasound (IVUS) or optical coherence tomography [OCT] for procedural guidance and importantly to optimize LM percutaneous coronary intervention [PCI] outcomes.

Recent Findings

Contemporary data regarding routine imaging-guided LM-PCI is discordant with small randomized trials and observational studies showing favorable rate of target lesion revascularization and cardiac death with contemporaneous larger trials failing to show such benefit with routine intravascular imaging for LM PCI.

Summary

Available data does not support routine intravascular imaging in all patients undergoing LM PCI but could possibly benefit less experienced operators and in the setting of complex two stent LM PCI strategies. Selective use of intravascular imaging in patients undergoing LM PCI is supported by contemporary data.