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Left main and multivessel disease

Find all the latest content on left main and multivessel disease published on this website.

The left main coronary artery provides the primary source of blood flow to the left ventricle. Diseases affecting the left main, by itself or in combination with multivessel disease, place the patient at significant risk for life-threatening cardiovascular events. Treatment requires an understanding of all available tools, devices and techniques, like those employed in invasive imaging and functional assessment, as well as taking into account underlying comorbidities such as diabetes. Advances in imaging techniques, as well as the use of adjunctive pharmacotherapy, vascular access or invasive interventions such as bypass surgery, are important, as are understanding bleeding risks. Use the filters below to access PCRonline resources.

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Left main and multivessel disease

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Outcomes after CABG compared with FFR-guided PCI in patients presenting with acute coronary syndrome

10 Jun 2025

This prespecified analysis of the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME 3) trial examined the impact on cardiovascular outcomes of treatment by CABG versus FFR-guided PCI in patients with three vessel disease (3-VD), stratified by acute (NSTEMI) or chronic coronary syndrome (CCS) presentation.

Ruxandra Sava

Reviewer

Ruxandra Sava
Nicola Ryan

Reviewer

Nicola Ryan
Outcomes after CABG compared with FFR-guided PCI in patients presenting with ACS

Coronary Interventions: EuroPCR 2025 highlights

22 May 2025 – From EuroPCR 2025

At EuroPCR 2025, Rasha Al-Lamee, Nieves Gonzalo, and Thomas Cuisset highlighted key advances in coronary interventions, with a strong emphasis on managing complex cases—particularly calcified lesions.

Throughout the Course, LIVE cases and expert hotlines showcased dedicated devices and evolving strategies designed specifically for these challenging lesions. Advanced...

Coronary: EuroPCR 2025 highlights

PCI for complex calcific coronary artery disease - LIVE Case

22 May 2025 – From EuroPCR 2025

An 87-year-old female patient, at high bleeding risk and with preserved LV function, presented 2 months ago with an inferior STEMI and multivessel disease. She initially underwent RCA PCI followed by staged LCx PCI. She was now referred for PCI of a long, heavily calcified lesion...

PCI for complex calcific coronary artery disease - LIVE Case

Through decisions in complex left main PCI – Left main trifurcation

22 May 2025 – From EuroPCR 2025

This session offers an in-depth analysis of complex left main trifurcation PCI, covering evaluation through imaging and physiology, lesion preparation strategies, and treatment options including stepwise provisional approaches, upfront two-stent techniques, and drug-coated balloons.

Through decisions in complex left main PCI – Left main trifurcation

Complex multivessel disease - LIVE Case

21 May 2025 – From EuroPCR 2025

An 89-year-old male patient presented with stable angina, preserved LV function and some risk factors such as hypertension and diabetes. CT scan and angiography revealed occlusion of proximal RCA and bifurcation lesions on LAD and circumflex (medina 1,1,1). Operators treated the bifurcation lesions with provisional stenting.
Regarding...

Complex multivessel disease - LIVE Case

First guidelines for the treatment of LM disease issued by SOLACI and SIAC

22 May 2025 – From EuroPCR 2025

During EuroPCR 2025, Cleverson Zukowski and Pablo Lamelas introduce a landmark initiative: the first clinical guidelines for left main disease specifically developed for Latin America.

Published by the Latin American Society of Interventional Cardiology (SOLACI) and the Interamerican Society of Cardiology (SIAC), these recommendations aim to support...

First guidelines for the treatment of LM disease issued by SOLACI and SIAC

How to manage treatment dilemmas in STEMI patients with multivessel disease?

20 May 2025 – From EuroPCR 2025

Managing STEMI patients with multivessel disease is a complex challenge evolving rapidly thanks to new clinical evidence. Angela Mcinerney, Natalia Pinilla, and Matthias Götberg explore how findings from the COMPLETE trial and its intracoronary imaging substudy are reshaping treatment strategies.

Their discussion highlights the role of intracoronary...

How to manage treatment dilemmas in STEMI patients with multivessel disease?

How to efficiently and safely manage calcified left main disease?

21 May 2025 – From EuroPCR 2025

Nicola Ryan and Flavio Ribichini explore the complexities of calcified left main stem disease, emphasizing the critical role of intracoronary imaging in improving patient outcomes. They discuss the practical use of mechanical circulatory support and debate stenting strategies, offering expert insights on when single or dual...

How to efficiently and safely manage calcified left main disease?

Feasibility of sheathless Impella for protected percutaneous coronary intervention: a single-center experience

02 May 2025

Impella CP microaxial flow pump supports complete revascularisation during high-risk PCI, but standard implantation often leads to vascular complications. This article explores an initial experience with a sheathless implantation technique, which shows promise as a feasible and safe alternative.

Sheathless Impella PCI

How should I treat a left main disease with multivessel diffuse CAD? Stenting only the necessary...

28 Feb 2025

A 71-year-old male patient with a clinicial history of hypertension, dyslipidemia and active smoking was admitted for NSTEMI.

Coronary angiography showed a left main (LM) stenosis involving the bifurcation and proximal parts of the left anterior descending (LAD) and left circumflex (LCx) arteries. Right coronary artery (RCA) showed a severe...

Eva Rumiz

Author

Eva Rumiz
How should I treat a left main disease with multivessel diffuse CAD? Stenting only the necessary