Multiple extensive coronary artery stenting: does it compromise future surgical revascularization?

Abstract:

PURPOSE OF REVIEW:In the era of percutaneous coronary intervention, surgeons are confronted with performing coronary artery bypass graft surgery on patients with previous balloon dilatation or stenting. This review evaluates the impact of previous percutaneous coronary intervention on patient survival and choice of optimal myocardial revascularization technique. RECENT FINDINGS:Aggressive atherosclerosis has been remarked in patients complicated with intrastent stenosis. Moreover, bypass grafting with venous grafts has shown an extremely high incidence of graft failure in the restenosis population due to limited nitric oxide (a natural vasodilator) production of venous grafts. The challenge is to achieve complete revascularization in an unfavourable setting (greater co-morbidities, complex coronary lesions) with a greater risk of graft occlusion. SUMMARY:The internal thoracic artery is the optimal graft for myocardial revascularization in patients with and without previous in-stent restenosis. Coronary artery reconstruction by exclusive internal thoracic artery grafting gives superior patency rates and clinical outcomes. It is the most appropriate approach for myocardial revascularization in these patients.

journal_name

Curr Opin Cardiol

authors

Al-Attar N,Nataf P

doi

10.1097/HCO.0b013e3282f0795d

subject

Has Abstract

pub_date

2007-11-01 00:00:00

pages

529-33

issue

6

eissn

0268-4705

issn

1531-7080

pii

00001573-200711000-00007

journal_volume

22

pub_type

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