Iatrogenic left main coronary artery (LMCA) stenosis is a rare but life-threatening complication that may occur after percutaneous coronary intervention (PCI) or cardiac valve surgery. While initially uninvolved, the LMCA can develop significant stenosis months after manipulation of other coronary vessels, raising diagnostic and therapeutic challenges. This review aims to synthesize existing case reports and clinical experiences regarding the development of iatrogenic LMCA stenosis in patients with no prior LMCA lesions, focusing on procedural causes and subsequent treatment strategies. A comprehensive review of the literature identified and analyzed a total of 14 publications comprising 8 multi-patient case series, 4 single case reports, and 1 retrospective cohort were identified, who developed iatrogenic LMCA stenosis following PCI or aortic valve surgery. Mechanisms, clinical presentations, diagnostic approaches, and outcomes of various treatment modalities were analyzed. The most common mechanisms included catheter-induced trauma, balloon overdistension, and ostial cannulation during valve surgery. Clinical presentation ranged from recurrent angina to cardiogenic shock. Treatment strategies included coronary artery bypass grafting, percutaneous coronary angioplasty with stenting, and in select hemodynamically stable patients, conservative medical therapy. PCI was often reserved for high-risk surgical patients or when rapid revascularization was essential. Iatrogenic LMCA stenosis should be considered in patients presenting with angina after coronary or valvular interventions, especially in the absence of prior LMCA disease. Early recognition through angiography and appropriate selection of revascularization strategy, surgical or percutaneous, is critical for optimizing outcomes.
Bozkurt et al. (2026) studied this question.