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Surgical revascularization was indicated whenever FFR was [http://en.wikipedia.org/wiki/Megestrol_acetate Megestrol Acetate] and drawbacks as assessment tools. The main limitations of IVUS reside in the potential lack of coaxiality and subsequent lumen distortion, as well as in the negative impact of irregular calcifications. Regarding FFR, the frequent concomitant presence of lesions in the descending anterior coronary artery, circumflex, or both interferes with a proper evaluation of the LMCA lesion. One advantage of IVUS over pressure wire is that this tool [http://www.selleckchem.com/products/SB-431542.html this website] can help both in the diagnosis and the treatment of lesions. A potential survival impact derived from the use of IVUS already has been proven (17). The main limitation of this study is that it was not randomized. Therefore, the value of the comparison between deferred and revascularized groups is limited by population differences between both strategies. Only a randomized trial can validate the value of revascularization according to pre-defined MLA cutoff points. However, considering the large body of evidence suggesting the clinical value of this cutoff criterion, we selected a pragmatic strategy in which this single criterion was selected to guide revascularization decisions. This was considered to be the only viable study (ethical issues were raised [http://www.selleckchem.com/products/INCB18424.html Ruxolitinib] in the initial discussions on study design). Another limitation is the lack of complete adherence to protocol, although protocol adherence was high and greater than in previous similar studies. A third limitation is the selection of patients based on the subjective operator criteria for intermediate lesions. However, this potential bias is reduced by the multicenter design. Finally, the follow-up period is only 2 years. However, the goal of this study resides in studying the ischemic potential of intermediate lesions, and not in assessing the progression of atherosclerotic lesions. Angiographic measurements are not reliable in the assessment of intermediate LMCA lesions. Ultrasonographic evaluation of intermediate LMCA lesions allows precise assessment of lesion severity, as well as lesion characteristics useful in cases where PCI is used to revascularize. An MLA of 6 mm2 or more seems to be a safe value for deferring revascularization of the LMCA, provided the application of the clinical and angiographic criteria used in this study. The authors thank Kristin Hood, Boston Scientific Corporation, for editorial support.