IMR Press / RCM / Volume 24 / Issue 1 / DOI: 10.31083/j.rcm2401026
Open Access Review
Imaging of Left Main Coronary Artery; Untangling the Gordian Knot
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1 Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece
2 First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
3 Department of Ophthalmology, University Medical Center Groningen, University of Groningen, 9700 Groningen, The Netherlands
4 Cardiology Department, Tzaneio Hospital, 18536 Pireaus, Greece
5 Second Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
6 Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, 6042 Charleroi, Belgium
*Correspondence: (Anastasios Apostolos)
Academic Editor: Jerome L. Fleg
Rev. Cardiovasc. Med. 2023, 24(1), 26;
Submitted: 27 September 2022 | Revised: 2 December 2022 | Accepted: 2 December 2022 | Published: 12 January 2023
(This article belongs to the Special Issue Intravascular imaging and Cardiovascular intervention)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Left Main Coronary Artery (LMCA) disease is considered a standout manifestation of coronary artery disease (CAD), because it is accompanied by the highest mortality. Increased mortality is expected, because LMCA is responsible for supplying up to 80% of total blood flow to the left ventricle in a right-dominant coronary system. Due to the significant progress of biomedical technology, the modern drug-eluting stents have remarkably improved the prognosis of patients with LMCA disease treated invasively. In fact, numerous randomized trials provided similar results in one- and five-year survival of patients treated with percutaneous coronary interventions (PCI) -guided with optimal imaging and coronary artery bypass surgery (CABG). However, interventional treatment requires optimal imaging of the LMCA disease, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The aim of this manuscript is to review the main pathophysiological characteristics, to present the imaging techniques of LMCA, and, last, to discuss the future directions in the depiction of LMCA disease.

left main disease
left main coronary artery
invasive coronary angiography
intravascular ultrasound
optical coherence tomography
percutaneous coronary intervention
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