Revascularization Considerations for Left Main CAD Although CABG has been considered the gold standard for unprotected left main CAD revascularization, more recently PCI has emerged as a possible alternative mode of revascu- larization in carefully selected patients. Lesion location is an important determinant when considering PCI for unprotected left main CAD. Stenting of the left main ostium or trunk is more straightforward than treating distal bifurcation or trifur- cation stenoses, which generally requires a greater degree of operator experience and expertise.176 In addition, PCI of bifurcation disease is associated with higher restenosis rates than when disease is confined to the ostium or trunk.39,177 Although lesion location influences technical success and long-term outcomes after PCI, location exerts a negligible influence on the success of CABG. In subgroup analyses, patients with left main CAD and a SYNTAX score 33 with more complex or extensive CAD had a higher mortality rate with PCI than with CABG.46 Physicians can estimate opera- tive risk for all CABG candidates using a standard instru- ment, such as the risk calculator from the STS database. The above considerations are important factors when choosing among revascularization strategies for unprotected left main CAD and have been factored into revascularization recom- mendations. Use of a Heart Team approach has been recom- mended in cases in which the choice of revascularization is not straightforward. As discussed in Section 2.9.7, the ability of the patient to tolerate and comply with dual antiplatelet therapy (DAPT) is also an important consideration in revas- cularization decisions. The 2005 PCI guideline8 recommended routine angio- graphic follow-up 2 to 6 months after stenting for unprotected left main CAD. 