Surgery revascularization

The challenge consists of identifying those at high enough risk, with a substantial amount of viable myocardium, who would benefit from revascularization. The criteria for selecting such patients include symptoms, collaterals, LV function, ischemic burden, associated indications for cardiovascular surgery or co-morbidities, and the amount of viable myocardium. 

The treatment of CAD for the alleviation of angina was evaluated in several trials that ultimately shaped the role of coronary angioplasty. Prior to this, trials such as the Veterans Administration Cooperative Study (VA Study) [13, 14] and the Coronary Artery Surgery Study (CASS) trial [15] established the role of revascularization for the improvement in survival and symptom relief A meta-analysis (Table 5.1) regarding surgical revascularization (CABG) versus... 

Inclusion criteria were similar to our previous pilot study (34), Patients with clinical indication of percutaneous coronary revascularization were randomized if they had a de novo severe stenosis in a native coronary artery, a lesion suitable for stent, and a reference vessel size between 2.5 and 4.0 by visual estimation, and were a candidate for coronary bypass surgery, All the PCI procedures were performed at the Catheterization Laboratories at Otamendi Hospital and Sanatorio Las Lomas in Buenos Aires, Argentina. 

The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996 335(4) 2l7-225. 

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... 

PC-stent CABO, coronary artery bypass graft surgery DISTINCT, Bio DivYsio stent in randomized control trial MACE, major adverse cardiac events MI, myocardial infarction NS, no significant difference TLR, target lesion revascularization. 

McNeer JE Conley MJ, Starmer CL et al. Complete and incomplete revascularization at aortocoronary bypass surgery experience with 392 consecutive patients. Am Heart J 1974 88(2) 176-182. 

Kleisli T Cheng W, Jacobs MJ, et al. In the current era, complete revascularization improves survival after coronary artery bypass surgery. J Thorac Cardiovasc Surg 2005 ... 

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. 

Lai BK. (2007). Cognitive function after carotid artery revascularization. Vascular and Endovascular Surgery 41 5-13 Levi CR, O Malley HM, Fell G et al. (1997). Transcranial Doppler detected cerebral microembolism following carotid endarterectomy. High microembolic signal loads predict postoperative cerebral ischaemia. Brain 120 621-629 Lindblad B, Persson NH, Takolander R et al. (1993). Does low-dose acetylsalicylic acid prevent stroke after carotid surgery ... 

CARESS Steering Committee (2005). Carotid Revascularization Using Endarterectomy or Stenting Systems (CARESS) phase I clinical trial 1-year results. Journal of Vascular Surgery 42 213-219... 

Stabilize the patient, medically and surgically, and provide definitive treatment of serious injuries, including major trauma, bums and respiratory injury if evident. Patients should receive necessary surgical interventions within 36 h and no later than 48 h after exposure surgery after that time is contraindicated for 6 weeks or until evidence appears that the patient is immunocompetent and that incised tissue is capable of revascularizing (10). 

High-risk patients with non-ST-segment-elevation ACS should undergo early coronary angiography and revascularization with either PCI or coronary artery bypass graft (CABG) surgery. 

Following risk stratification, pharmacotherapy for non-ST-segment-elevation ACS is initiated. Urgent (within 24 hours) coronary angiography and revascularization of the infarct-related coronary artery with PCI or CABG surgery is considered for moderate- and high-risk patients (see Fig. 16-1 and Table 16-2). 

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