Webinar 10 | Assessment of Left Main Stenosis-Slides: Intravascular Imaging Guided LM Interventions, Dr. Yoshinobu Murasato

Slides: Intravascular Imaging Guided LM Interventions, Dr. Yoshinobu Murasato

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This presentation by Dr. Yoshinobu Murasato analyzed outcomes of left main percutaneous coronary interventions (LM-PCI) guided routinely by intravascular imaging in a large Japanese registry (LM-JANHO) involving 806 patients across 19 hospitals from 2016-2020. Imaging guidance was used in 97.7% of cases, primarily by IVUS (86.5%) and OCT (12.2%). The study included complex lesions, with 78% involving bifurcations and 31.2% presenting as acute coronary syndrome (ACS).<br /><br />Key findings showed a 1-year major adverse cardiovascular and cerebrovascular event (MACCE) rate of 17.5%, driven mainly by all-cause mortality (8.9%) and clinically driven revascularization (8.2%). Two-stent techniques and use of mechanical circulatory support were associated with higher MACCE risk (hazard ratios ~2), likely reflecting more complex disease and presentations. Radial access and higher left ventricular ejection fraction (LVEF) were protective factors. Despite routine imaging optimizing local PCI results and preventing unnecessary intervention on side branches, patients with severe LV dysfunction or multiple vessel involvement had increased mortality and revascularization.<br /><br />Three-year follow-up confirmed higher MACCE and mortality in ACS cases, mostly due to early deaths within 30 days post-PCI. Clinically driven revascularization rates did not differ between ACS and non-ACS, suggesting imaging guidance maintains local efficacy even in complex ACS settings. Comparison between one- vs. two-stent strategies showed no significant outcome differences after matching for lesion complexity, although two-stent approaches were linked to more severe lesions and higher revascularization before adjustment.<br /><br />Imaging played vital roles in accurate lesion assessment beyond angiography, guiding stent sizing, optimizing proximal optimization technique (POT), detecting hidden disease, preventing stent malapposition or deformation, and ensuring proper wire crossing especially in bifurcations.<br /><br />In summary, routine intracoronary imaging guidance enhances PCI quality and outcomes in LM disease, particularly by avoiding unnecessary stenting and optimizing results. However, high-risk patients with severe LV impairment or complex multivessel disease still face significant risk, highlighting the need for comprehensive systemic and hemodynamic management alongside imaging-guided PCI.

Keywords

left main percutaneous coronary intervention

intravascular imaging

IVUS

OCT

major adverse cardiovascular and cerebrovascular events

two-stent technique

mechanical circulatory support

radial access

left ventricular ejection fraction

acute coronary syndrome