Hey - I can totally relate to your situation with the treatment decision regarding your Left Main Coronary Artery (LMCA). I too have just learned from Mayo after my Angiogram that my LMCA has a blockage at the bifurcation of just over 50%, and the recommendation is CABG versus angioplasty and stenting. I also have a 70% blockage in my right coronary artery, and 60% in my first LAD D1 branch.

We are a part of a smaller percentage of people with CAD that have LMCA stenosis. Most people (roughly 90%) do not, and their concerns typically revolve around the LAD because it's called the "widowmaker". The LMCA is actually the widowmakers widowmaker in a way, because it's the MAIN artery that feeds the LAD downstream, so that is why it has a revascularization cutoff of 50% versus the 70% cutoffs for other blocked vessels.

Most treatment modalities indicate CABG for LMCA stenosis because of this, but factors like the lesions location (ostial, distal, proximal), it's length and characteristics, is it at the bifurcation, FFR and IFR values, surgical candidacy...etc, play a role in how it's approached. If it's complex for stenting, multiple vessel disease, and you're a good candidate for surgery, the best long term outcomes historically lean towards CABG versus PCI, and that's why it's the common approach to it, but some situations can make stenting the left main feasible.

I feel for you, man. This came out of left field for me while being screened for something unrelated. I have no angina, haven't had a heart attack or cardiac episode, did fine on my stress echo, and my worse symptoms are some shortness of breath under exertion - so it's tough to face this choice for CABG surgery. I am scheduled for July 2nd at Mayo Rochester since I live 2 hours from there, but I have an appointment with an interventionist just to cover my bases and reconfirm that angioplasty isn't a viable option for me. I'm 57, and have never had a surgery - so this is pretty intimidating to wrap my head around. My surgeon said it would be three vessels bypassed for me.

Were you having symptoms like angina? Did the interventional cardiologist who did your angiogram explain why they didn't stent anything when they were in there?