Percutaneous treatment of left main coronary stenosis.

To the Editor: The multicenter report by Dr Ellis and colleagues1 of 107 patients with left main coronary obstruction who were not candidates for surgery and in whom an attempt was made to reopen the left main coronary vessel by percutaneous techniques with different devices has significant implications for the cardiac surgeon when the patient is a candidate for a surgical procedure. Ellis et al deserve to be congratulated for this important piece of information. There have been numerous reports of patients who have undergone direct attempts to widen the left main trunk of the coronary artery to provide antegrade flow when the distal branches are not significantly involved with obstructions. One of the main complications of this approach is early restenosis of the vessel and, occasionally, total occlusion, with fatal consequences for the patient. It appears that the main trunk of the coronary artery reacts unfavorably to endarterectomy procedures or any type of trauma damaging the …

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