Treating multivessel disease in the era of coated stents: conclusion.

T he worse long term outcome observed after percutaneous transluminal coronary angioplasty (PTCA) than after coronary artery bypass grafting (CABG) in patients at high risk of restenosis and disease progression such as diabetics, remind us that there is a substantial difference between treating a focal lesion with percutaneous coronary intervention and the use of arterial or vein grafts which bypass all proximal and mid segments of native coronary arteries. Interventionalists may argue that repair of the native arteries avoids the problem of accelerated disease of the bypass conduits and the occlusion of native arteries often seen years after implantation of vein grafts, situations difficult to handle both with surgery and angioplasty. Still, at least in the first few years after CABG and possibly much longer for arterial grafts, a bypass operation also prevents the acute events due to progression of disease in proximal and mid coronary segments arising from lesions that had no significant narrowing or only minor irregularities at the time of the initial treatment.