CABG or PCI for this left main NSTEMI?

This elderly woman of 76 y.o. is admitted directly in the cath lab from the emergency department for chest pain and an ECG showing important ST depression in the anterior leads. She is sent directly to the cath lab due to limit blood pressure at 90mmhg. Coronary angiography found a distal calcified left main sub-occlussion (block of calcium in the distal LM). Syntax score 17, CRUSADE high, GRACE high. PCI was decided a few hours later, during the Heart Team meeting. After wiring the CX, rotablation was performed, followed by pre-dilatation and LM-CX stent implantation. POT, side branch (LAD) balloon and RE-POT was performed, with a good angiographic result at the end of the procedure. Would you have treated otherwise?

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How would you treat this left main?

How would you treat this left main?

Elderly man of 87 y.o. is hospitalized for chest pain and negative T waves on ECG. Positive troponin. After medical treatment, the patient was still symptomatic but with good hemodynamic parameters. I performed a coronary angiography at 2 hours after hospitalization, and found a left main proximal stenosis of 90%. Syntax score 7, CRUSADE moderate (36), GRACE high. After wiring the LAD and CX, with an additional BMW in the aorta, pre-dilatation was performed with a 4 mm balloon. A short 4 mm stent was implanted, post-dilated with a short noncompliant balloon of 5mm. Would you have treated otherwise?

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