Myocardial revascularization
In medicine, myocardial revascularization is "the restoration of blood supply to the myocardium."[1]
Revascularization procedures include:
- Coronary artery bypass grafting(CABG) which is a "surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion."[2]
- Percutaneous transluminal coronary angioplasty (PCTA) (angioplasty of a coronary artery) is "dilatation of an occluded coronary artery (or arteries) by means of a balloon catheter to restore myocardial blood supply."[3]
- Coronary atherectomy which is a "percutaneous transluminal procedure for removing atheromatous plaque from the coronary arteries. Both directional (for removing focal atheromas) and rotational (for removing concentric atheromatous plaque) atherectomy devices have been used."[4]
Coronary artery bypass is more effective for myocardial revascularization of coronary heart disease than percutaneous transluminal coronary angioplasty[5], especially for patients with diabetes who have stenosis of three coronary arteries.[6] Coronary artery bypass is also more effective than percutaneous transluminal coronary angioplasty with drug-eluting stents; however, bypass may increase the rate of stroke.[7] The SYNTAX score may help determine choice of procedure for myocardial revascularization.[8]
Of patients without indications for myocardial revascularization, cardiologists will recommended percutaneous transluminal coronary angioplasty for 21% of patients.[9] A second study found that 12% of percutaneous transluminal coronary angioplasties were done for inappropriate reasons.[10]
References
- ↑ Anonymous (2024), Myocardial revascularization (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Anonymous (2024), Coronary Artery Bypass (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Anonymous (2024), Percutaneous transluminal coronary angioplasty (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Anonymous (2024), Coronary Atherectomy (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Bravata DM, Gienger AL, McDonald KM, et al (2007). "Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Surgery". Ann Intern Med. PMID 17938385. [e]
- ↑ (July 1996) "Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators". N. Engl. J. Med. 335 (4): 217–25. PMID 8657237. [e]
- ↑ Serruys PW, Morice MC, Kappetein AP, et al (March 2009). "Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease". N. Engl. J. Med. 360 (10): 961–72. DOI:10.1056/NEJMoa0804626. PMID 19228612. Research Blogging.
- ↑ Valgimigli M, Serruys PW, Tsuchida K, et al (April 2007). "Cyphering the complexity of coronary artery disease using the syntax score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention". Am. J. Cardiol. 99 (8): 1072–81. DOI:10.1016/j.amjcard.2006.11.062. PMID 17437730. Research Blogging.
- ↑ Hannan EL, Racz MJ, Gold J, Cozzens K, Stamato NJ, Powell T et al. (2010). "Adherence of catheterization laboratory cardiologists to American College of Cardiology/American Heart Association guidelines for percutaneous coronary interventions and coronary artery bypass graft surgery: what happens in actual practice?". Circulation 121 (2): 267-75. DOI:10.1161/CIRCULATIONAHA.109.887539. PMID 20048207. Research Blogging.
- ↑ Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K et al. (2011). "Appropriateness of percutaneous coronary intervention.". JAMA 306 (1): 53-61. DOI:10.1001/jama.2011.916. PMID 21730241. Research Blogging.