<International Circulation>: How do you plan for antiplatelet therapy after DES revascularization for left main coronary artery disease? Are there any special considerations compared to intervention for other coronary lesions?

Dr. Kandzari: In the left main indication， stent thrombosis can be clinically catastrophic and so for many clinicians this would be an instance in which they might recommend lifelong dual antiplatelet therapy. It turns out， however， that the risks of stent thrombosis in the left main setting are relatively uncommon. They may be even less common than in other lesion complexities. It may be related to the large caliber of left main artery being associated with a lower incidence of stent thrombosis. Many clinicians would prescribe longer durations in the left main setting but whether it is necessary or not is something we will learn more about in the upcoming EXCEL trial. The EXCEL trial is going to be sponsored by Abbot Vascular and it will enroll about 2500 patients globally and will randomize patients to either surgery or PCI for unprotected left main disease. The recommendations in that trial will be at least one year according to current guidelines but certainly many clinicians by preference will treat patients for longer durations and we will learn more about the risks and benefits of shorter and longer durations from that trial.

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