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| Dr Gershlick trained in
cardiology in London and
moved to the University of
Leicester in 1990 to take up
a formal Senior Lecturer's
post, transferring to the
NHS in 1993. However, he
has maintained a significant
research interest, publishing
extensively in the area of
vessel wall/blood interactions
especially those that occur
following percutaneous
coronary intervention.
Research has included basic
laboratory work involving
drug-eluting stents, and
he has also been principal
investigator in a number of
national and international
studies. Dr Gershlick is
currently involved in studies
of myoblast injection and
bone marrow cells for patients
with failed lysis and impaired
left ventricular function. He
is a council member of
the British Cardiac Society,
Scientific Officer of the British
Cardiovascular Intervention
Society and Chairman of
the local Cardiovascular
Programme Board. |
Left main stem stenting
Anthony H Gershlick
University Hospitals of Leicester
Address for correspondence:
Dr Anthony H Gershlick
Consultant Cardiologist
Clinical Sciences Department, Glenfield Hospital
Groby Road, Leicester, LE3 9QP, UK
Tel: +44-(0)116-256-3887 Fax: +44-(0)116-287-5792
Email: agershlick@aol.com
Unprotected stenosis of the left main coronary artery greater than 50% has traditionally been managed
with coronary artery bypass surgery (CABG). There is now emerging evidence to support the use of
percutaneous coronary intervention (PCI) with drug-eluting stents, especially in patients at high risk for
surgery. However, the widespread use of PCI instead of CABG remains very controversial.
In this issue, an interventional cardiologist discusses this question and presents his own perspective on
the appropriate selection of therapeutic strategy. The available evidence is reviewed and summarized and
some of the unanswered questions are highlighted. Several large clinical trials comparing percutaneous to
surgical intervention are currently in progress and the results of these will help clarify the situation.
In the next issue, the question will be viewed from the perspective of a cardiac surgeon. |
Abstract
Percutaneous treatment of obstructive coronary
disease has, for a number of years, been undertaken
more commonly than the coronary artery bypass graft
(CABG). Technical developments, operator skill and the
advent of drug-eluting stents has meant that most
lesions can be treated effectively with little associated
morbidity and with rapid patient discharge. When
considering more complex disease two issues need to
be considered:
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Can it be technically undertaken safely
with percutaneous coronary intervention (PCI)?
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Are there data to suggest the benefit of one
revascularisation technique over another?
There are no robust data that approach the rigours of
unchallengeable evidence to support CABG over PCI.
The only randomised study comparing the two will be
published in 2008. In the meantime, each case should
be viewed individually – patients with co-morbidity
or with lesions in the ostium or the body should be
seriously considered for PCI. Those with bifurcation
disease might, because of the increased technical
aspects of PCI in such cases, be considered for CABG.
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