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For coronary artery disease with unprotected left main stem (LMS) stenosis, coronary artery bypass grafting (CABG) is traditionally regarded as the "standard of care" because of its well-documented and durable survival advantage. There is now an increasing trend to use drug-eluting stents for LMS stenosis rather than CABG despite very little high-quality data to inform clinical practice. We herein: 1) evaluate the current evidence in support of the use of percutaneous revascularization for unprotected LMS; 2) assess the underlying justification for randomized controlled trials of stenting versus surgery for unprotected LMS; and 3) examine the optimum approach to informed consent. We conclude that CABG should indeed remain the preferred revascularization treatment in good surgical candidates with unprotected LMS stenosis.

Original publication

DOI

10.1016/j.jacc.2007.09.067

Type

Journal article

Journal

J Am Coll Cardiol

Publication Date

04/03/2008

Volume

51

Pages

885 - 892

Keywords

Consent Forms, Coronary Artery Bypass, Coronary Restenosis, Coronary Stenosis, Coronary Thrombosis, Drug-Eluting Stents, Humans, Treatment Outcome