Arterial revascularization therapies study

Serruys FW, Ong AT, van Herwerden LA, et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized... 

Abizaid A, Costa MA, Centemero M, et al. Arterial Revascularization Therapy Study Group. Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients insights from the Arterial Revascularization Therapy Study (ARTS) trial. Circulation 2001 104(5) 533—538. 

Serruys PW, Unger p Sousa JE, etal. Arterial Revascularization Therapies Study Group. Comparison of coronary artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med 2001 344 1 117-1124. 

Reperfusion as predictor of follow-up infarct volume. Revascularization therapies in acute ischemic stroke patients aim to rescue the ischemic penumbra by restoring the patency of the occluded artery (recanalization) and the downstream capillary blood flow (reperfusion). Although reperfusion and recanalization have been used interchangeably, the terms describe two distinct concepts [236]. Earlier studies supported the benefit of early recanalization in predicting smaller infarct volumes and clinical outcomes [2, 237, 238]. However, more recent studies have shown that recanalization does not always lead to reperfusion [239, 240]. One explanation is that the main clot may be fragmented and occlude smaller, downstream arterial branches, not allowing capillary reperfusion [241]. A second, distinct, but complementary reason is the noreflow phenomenon even if recanalization is achieved, tissue edema may not allow blood flow [242, 243]. 

The more recent use of aggressive medical therapy with beta blockers, ACE-inhibitors, aspirin, and HMG Co A reductase inhibitors has had a profound benefit on those with coronary artery disease and reduced LVEF. To that end, revascularization still plays an important role in mortality reduction. In the Studies of Left Ventricular Dysfunction (SOLVD) database, CABG does improve survival compared to more modern use of medical therapy, with a 25% mortality risk reduction as well as an intriguing 46% risk reduction of sudden death [91]. This benefit improved as LVEF decreased, thus providing evidence that revascularization may stabilize heart function, reduce abnormal remodeling, and thus reduce the propensity to arrhythmogenicity. 

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