Complex coronary artery disease: Left Main Trunk, Multiple Arterial Vessels Disease, Total Occlusions and Bifurcations
Complex coronary obstructions, namely the Left Main Trunk, Multiple Arterial Vessels Disease, Total Occlusions and Bifurcations were field of surgical solution in the past decade. At present, scientific evidence is available to justify percutaneously the resolution of this type of injury. With the advent of drug-coated Stent or medicated Stent, post-revascularization results in the long term are quite flattering. So nowadays and every day, we are solving complex patient cases in Cath Lab through angioplasty plus Stent implantation. Syntax Study results (www.syntaxtrial.com) comparing Myocardial Revascularization Surgery against Angioplasty plus Stent in Patients with Left Main Trunk lesions plus 2 or 3 coronary vessels disease, showed that long-term mortality is comparable with both techniques. A benefit was obtained by the bypass surgery only in relation to the slightest possibility of repeating the revascularization in patients who would be in a surgery and in those patients who had a Syntax Score > 33. It is important to emphasize those patients who were in a Bypass surgery compared to those who had Stents, had a higher risk of ischemic stroke complication. It is also noteworthy that the best therapeutic decision must be taken with each patient individually, taking into account their opinion and family by managing the best available scientific information applicable in a given clinical situation. In this sense the medicated stent implantation has provided sufficient long-term safety with good clinical results which justify its use in complex cases.
