Revascularization for Coronary Artery Disease: Stents Versus Bypass Surgery

Abstract

Coronary artery disease (CAD) is one manifestation of ischemic heart disease, which is the leading cause of mortality in the world. In addition to preventive medical therapy and lifestyle changes, consideration of revascularization of obstructed arteries to reduce ischemia, alleviate angina, and improve quality of life is a mainstay of current practice. However, the benefits of different methods of revascularization in particular patient populations are debated. Percutaneous coronary intervention (PCI), which involves placement of intracoronary stents in most patients, is a less invasive procedure than coronary artery bypass graft (CABG) surgery. Although it is generally accepted that patients with single-vessel obstructive CAD are best treated with PCI, patients with multivessel CAD have a higher ischemia burden, a greater risk for developing recurrent ischemic events, and a higher mortality. It is in this patient population where the debate over revascularization with stents versus surgery continues.

Surgery and new Pharmacological strategy in some atherosclerotic chronic and acute conditions

“…Although it is generally accepted that patients with single-vessel obstructive CAD are best treated with PCI, patients with multivessel CAD have a higher ischemia burden, a greater risk for developing recurrent ischemic events, and a higher mortality. It is in this patient population where the debate over revascularization with stents versus surgery continues [11].…”

Gene delivery nanoparticles to modulate angiogenesis

“…In contrast, sustained hypoxia instigates the production of pro-angiogenic signals and new capillary networks within the ischemic region. To improve patient outcome, medical intervention, often in the form of angioplasties, bypasses, stents, or anti-coagulant therapy, are usually employed as well [108–110]. However, these approaches are not always sufficient to restore normal tissue function.…”

Preoperative management of antiplatelet drugs for a coronary artery stent: how can we hit a moving target?

“…With the advent of percutaneous coronary intervention (PCI), specifically the bare metal stent (BMS) and subsequently, the drug-eluting stent (DES), the scope of interventional cardiology has greatly increased [1-3]. An estimated 600,000 coronary artery stents are placed annually in the United States (US) for the management of acute and chronic coronary artery disease [4].…”

“…Given the aging US population and its increasing prevalence of coronary artery disease, the use of coronary artery stents will likely continue to grow. These biomedical devices appear to have reduced the number of more invasive coronary artery bypass surgeries [1,4]. However, US Medicare expenditures for drug-eluting stents alone (not including the cost of chronic antiplatelet drugs) are currently estimated to be $1.57 billion per year and are expected to increase [5].…”