CORONARY ANGIOPLASTY VS BYPASS-SURGERY IN PROXIMAL LEFT ANTERIOR DESCENDING ARTERY-STENOSIS

The points of view of the cardiac surgeon and the interventional cardi ologist on their personal approach to the treatment of the significant lesions of the proximal left anterior descending coronary artery are still a matter of controversy. Two randomized studies have compared th e efficacy of PTCA vs CABG in the treatment of patients with isolated proximal left anterior descending (LAD) coronary artery stenosis. Afte r a mean follow-up of 3 years these studies concluded that the inciden ce of events was significantly reduced in the CABG group. However, thi s conclusion requires a cautious interpretation because of methodologi cal limitations of these studies. On the other hand, a recent randomiz ed study has shown a reduction in the restenosis rate when an intracor onary stent is electively implanted after PTCA in proximal LAD stenosi s. Similarly, surgical modifications in material and in technical aspe cts will probably result in a reduction of the morbidity sometimes ass ociated with surgical procedures. Presented with favourable anatomy, P TCA with elective stent implantation may be the initial option in the treatment of proximal LAD stenosis, especially if another revasculariz ation procedure is contemplated in the future. However, CABG is prefer red when the LAD lesion suggests a complicated anatomy (chronic obstru ctions, ostial lesions or proximal bifurcations with a significant dia gonal). Depending on the particular results for both procedures in eac h Institution, an individual evaluation seems to be mandatory in the v ast majority of patients.