Coronary artery bypass surgery is not in competition with PCI (coronary angioplasty with intracoronary stent). The two methods of treatment are complimentary. Many of the surgical studies listed were done without the use of internal mammary artery grafts. Also, the PCI studies consist mainly of coronary angioplasty with only some patients receiving stents. Most important, the new drug-eluting stents are superior to older stents and produce up to 90% reduction in stent stenosis (a restenosis rate of <5%). Randomized clinical trials that compare internal mammary artery grafts and the drug-eluting stents are necessary to evaluate these two strategies.
Despite the usefulness and popularity of bypass surgery, alternatives are being sought that may avoid the morbi¬dity of a sternotomy, aortic cross-clamping, and the neurocognitive sequelae of cardiopulmonary bypass. This is particularly important in individuals over age 70.
A. Drug-Eluting Stents
These stents will undoubtedly be the preferred treatment of choice for the following:
• Single-vessel disease
• Double-vessel disease with a near normal or normal EF
• Some patients with triple-vessel disease, normal left ventricular function, and an EF equal to or greater than 50%

Страницы: 1 | 2 | 3 | 4