Seems to me your answers are the same pretty well. One of the models of atherosclerosis involves rubbing away the vascular endothelium with a catheter. And if the animal (subject) is vulnerable to atherosclerosis, this is effectively what develops. I didn't know of this observation so that's helpful for me! I suspect both processes will occur, platelet deposition leading to accelerated atherosclerosis or in other subjects, a process more like post-PCI restenosis.

Dear

Dr khaled, I totally agreed with Dr Adams's answar. Repeated trauma of left main endothelium by guide catheter, passage of balloons and stents leads to deposition of platelet and fibrin and initiates the luminal narrowing probably. IVUS study in these patients may be very useful to evaluate the morphology of LMCA lession and to differentiate from de no atherosclerosis. Thanks

Very interesting question! Have anyone actually observe that in a study? I haven't come across something like that.

I do not think that multiple PCI can later lead to left main disease. Also, I am not aware of any studies supporting such an observation. If left main ostium or shaft has some plaques, one can infrequently encounter guide catheter induced dissection or some issues related to use of other hardware like guideliner or rotablator or even difficult stent tracking. But these issues should be identified and tackled in the Cath Lab itself.

I must admit, I assumed that Khaled Alebrahim had seen a study which showed increased LMS disease or else the question is meaningless. Perhaps he could share the reference?

Thanks Philip. There are no such studies . It is just an observation ofnew significant left main disease post cath or PCI in patients with previously normal left main . I wounder if any one share the same observation .

There's data about left main disease after cannulation of the coronaries for cardiac surgery of course.

I have seen many patients with re-intervened coronary arteries but haven't recognized a higher prevalence of left main disease among these patients. Perhaps we need to confirm the observation first before speculating any supporting theories? In addition, long-term outcome of PCI and CABG are similar now, a more prevalent left main disease after PCI may tip the balance different?