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Determining the most appropriate revascularization strategy for patients presenting with unprotected left main coronary (UPLM) disease has been a topic of great recent interest. During this current decade, there have been multiple clinical trials and registries addressing this subject. Previously, UPLM disease has almost exclusively resulted in utilizing a surgical revascularization treatment strategy. However, recent improvements in percutaneous coronary intervention (PCI) techniques in parallel with the benefits of drug-eluting stents (DES) to reduce clinical restenosis have enabled further investigation in catheterization-based treatment strategies as possible alternative therapeutic options. These advances as well as an increased understanding of both the procedural and anatomical challenges involved with complex coronary interventions have allowed further advancements in the field. Better adjunctive antithrombotic pharmacological therapy in the PCI setting has favored such progress. American College of Cardiology/American Heart Association/Society for Coronary Angiography and Interventions guidelines do not currently endorse the performance of PCI as an appropriate alternative to surgical revascularization for patients with UPLM disease. This paper is a review of the current evidence on UPLM PCI and proposes future directions in this evolving field. [Copyright &y& Elsevier]

Abstract: During diagnostic angiographic procedures or percutaneous coronary angioplasty-stenting of the other coronary arteries, the overall risk for a complication related to the left main coronary artery (LMCA) is low; however, if such complications occur, they tend to be life-threatening and contribute to a large part of the total catheter-related mortality. We encountered a case of iatrogenic significant subtotal left main coronary artery thrombotic stenosis in a patient who had undergone prior percutaneous transluminal coronary artery angioplasty-stenting of the left circumflex artery. In light of the literature, an extremely rare clinical presentation of iatrogenic left main coronary artery thrombosis is discussed. [Copyright &y& Elsevier]

Abstract: The coexistence of Brugada Syndrome and resting vasospastic angina resulting in cardiac arrest is rare. We describe a 64year-old man presenting with cardiac arrest and vasospastic angina with diagnostic criteria of symptomatic Brugada Syndrome. Recognition of the coexistence of these potentially fatal conditions has important therapeutic implications when using calcium channel antagonists and may shed light on the mechanisms of coronary spasm. A common pathogenesis, such as a common underlying channelopathy, may explain its coexistence with Brugada Syndrome. [Copyright &y& Elsevier]

Abstract: Thirty years after LMCA balloon angioplasty was performed. LMCA percutaneous intervention is still controversial because of its potential complications due to this site and of the good results of LMCA surgery. The poor balloon angioplasty is definitively given up. For the first time, bare stents were used in the middle of the 90 with excellent results concerning the in-hospital and one-year mortality, with a high rate of repeated revasculm-isation (TLR from 15 to 20 %). After the introduction of DES several physicians demonstrated the feasibility and the acceptable one-year mortality of this « off-label « indication; furthermore, cumulative experience with DES treatment for LMCA have naturally shown a reduction of the target vessel revascularisation. Nevertheless follow-up at 3 and 5 years of randomized compm-isons with CABG surgery will be necessary to dedicate LMCA eluting stenting as the new gold standard. [Copyright &y& Elsevier]