Left main and multivessel disease

Alessandro Sticchi provides us with a curated overview of the late-breaking trials he found most relevant for interventional cardiologists from AHA 2025.

A 59-year-old male presented with CCS for three months, with diabetes and normal LV function (72%). Coronary angiography showed a calcified left main stenosis (Medina 1,1,1) and diffuse calcification of the proximal and mid LAD. The LCX QFR was 0.86.

Treatment included extensive lesion preparation with lithotripsy...

A 78-year-old male with a history of LAD PCI in 1997 presented with an NSTEMI three months earlier due to diffuse three-vessel calcified disease, including: distal LM stenosis, severe mid and distal disease of a dominant RCA, and LAD in-stent restenosis. LV function was normal. He...

A 51-year-old man with an inferior STEMI and multivessel disease was found to have a thrombotic sub-occlusion in the mid RCA. Angiography also revealed significant disease in the LAD. How would you manage this case?

Mirvat Alasnag provides her take on OPTION-STEMI, presented by Youngkeun Ahn at ESC Congress 2025 in Madrid.

Analyse this case to find out how to successfully manage a patient with a severely calcific left main stenosis and severely reduced ejection fraction.

This case illustrates how a fragile patient with severe three-vessel disease involving LM/LAD was treated. Watch now to find out more, and share your thoughts!

This PCR Textbook outstanding chapter written by F.J. Neumann and colleagues reviews the management of left main coronary disease, comparing PCI and CABG, emphasising patient-specific factors, heart team input, and PCI techniques including imaging and antithrombotic therapy. Available exclusively to subscribers.

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.

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...