PubMed · 9258489
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J R Resar, J A Brinker. 1997. Bridge work.. https://doi.org/10.1002/(sici)1097-0304(199708)41%3A4%3C421%3A%3Aaid-ccd18%3E3.0.co%3B2-o
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BACKGROUND: Angioplasty has become an accepted treatment of patients with coronary artery disease and is now commonly used to treat patients with multivessel disease. The major disadvantage of angioplasty has been restenosis requiring repeat interventions with resultant loss of initial cost savings. Compared with the right and the circumflex coronary arteries, the left anterior descending artery (LAD) has been more adversely affected by restenosis. Recently, minimally invasive direct coronary artery bypass (MIDCAB) to the LAD through a small left anterior thoracotomy using the left internal mammary artery has been performed in some centers with excellent early results and with reduced costs compared with standard bypass surgery. METHODS AND RESULTS: We retrospectively reviewed the first 31 consecutive patients treated in our institution with integrated coronary revascularization (ICR): MIDCAB to the LAD combined with PTCA of the other diseased vessels in patients with multivessel disease. Postoperative angiography in 84% of patients revealed a patent anastomosis and normal flow in the graft and bypassed vessel. Thirty-eight (97%) of 39 vessels were successfully treated percutaneously. At a mean follow-up of 7 months, all patients are currently asymptomatic. There have been 2 adverse clinical events, both related to angioplasty and not to MIDCAB. The average length of stay at the hospital after MIDCAB was 2.79+/-1.05 days. CONCLUSIONS: These preliminary results with ICR are encouraging and suggest that a randomized, prospective clinical trial comparing ICR with standard coronary artery bypass surgery for the revascularization of symptomatic patients with multivessel disease involving the LAD is warranted.
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Although the use of coronary stents has virtually abolished the threat of periprocedural obstructive dissection, subacute and acute intracoronary thrombosis and late restenosis remain a major problem with catheter-guided transluminal coronary interventions, despite significant technical advances over the last 10 years. Acute stent thrombosis emerged as a new problem with the introduction of metallic coronary prostheses (stents), which unfortunately represent an ideal stimulus for platelet deposition. Recently, dramatic progress has been achieved by focusing on the inhibition of thrombin and platelets, before and during interventional procedures. This has stimulated the search for powerful and well-tolerated antithrombotic agents-platelet inhibitors and antithrombins-so that long-term (oral) administration may become possible, if necessary. The current roles of unfractionated and low-molecular-weight heparins (LMWHs), direct thrombin inhibitors (such as hirulog and hirudin), antiplatelet agents (such as aspirin, clopidogrel, and ticlopidine) and the potential of the glycoprotein IIb/IIa receptor blockers are reviewed and put into perspective with respect to their acute and long-term clinical value.