Atherectomy of the left main coronary artery with percutaneous cardiopulmonary bypass support.

L eft main (LM) coronary artery stenoses have conventionally been precluded from percutaneous coronary angioplasty because of the prohibitive risk of irreversible hemodynamic collapse after acute closure of the artery, and a relatively high risk of late sudden death. l When protected by left anterior descending and circumflex coronary artery bypass grafts, angioplasty of the LM coronary artery can be safely performed but is limited by a rate of recurrent stenosis in excess of 50%.* Coronary atherectomy has recently been advocated as an alternative procedure because of preliminary data suggesting a lower incidence of acute