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Revascularization of significant Left Main Stem (LMS) disease improves clinical outcomes. This can be achieved through either Coronary Artery Bypass Grafting or Percutaneous coronary intervention. Defining a significant stenosis of the LMS can be challenging and debatable, as most data have been derived using angiographic assessment alone, with a threshold of 50% luminal stenosis used as a marker of functional significance. The use of adjunctive technologies like Intravascular Ultrasound and Fractional Flow Reserve has improved our ability to accurately assess the anatomical severity and physiological significance of coronary artery stenoses, much more so, than can be achieved through conventional angiography alone. An improved assessment of LMS disease through these adjunctive techniques offers procedural and clinical benefits. Rather than focus on the preferred methods of revascularisation, this article aims to highlight the common pitfalls and misconceptions in the assessment of LMS stenoses. We also propose a simple algorithm for the assessment of LMS disease to help guide revascularisation decisions.

Original publication




Journal article


Cardiovasc Revasc Med

Publication Date





51 - 56


FFR, IVUS, Left main disease, Revascularization, Cardiac Catheterization, Clinical Decision-Making, Coronary Angiography, Coronary Artery Bypass, Coronary Artery Disease, Coronary Stenosis, Coronary Vessels, Fractional Flow Reserve, Myocardial, Humans, Patient Selection, Percutaneous Coronary Intervention, Predictive Value of Tests, Prognosis, Reproducibility of Results, Severity of Illness Index, Ultrasonography, Interventional