title: Primary stenting versus MIDCAB: preliminary report-comparision of two methods of revascularization in single left anterior descending coronary artery stenosis.
abstract: BACKGROUND
  Percutaneous revascularization is a well-accepted method of treatment for a single left anterior descending coronary artery (LAD) stenosis. With the introduction of primary stenting, it has become the treatment of choice for a LAD lesion. In the last few years however, the introduction of minimally invasive cardiac surgery, video-assisted left internal thoracic artery (LITA) harvesting, and robotic surgery have raised the question as to whether minimally invasive surgical revascularization would be competitive with percutaneous coronary interventions in cases of single-vessel stenoses.
  
  
  METHODS
  A group of 100 patients with Canadian Cardiovascular Society class II to IV, and angiographically confirmed single critical stenosis of the LAD (type A or B), were treated with direct primary stenting (group 1, n = 50), or with endoscopic atraumatic coronary artery bypass grafting (group 2, n =50).
  
  
  RESULTS
  All patients in a group 1, obtained a very good angiographic and clinical effect. No acute postoperative complications were noted at 1 month of follow-up. However, at 1 month of follow-up, 3 patients (6%) developed restenosis of the LAD, and at 6 months follow-up, 6 patients (12%), developed restenosis of the LAD. In these cases, repeated percutaneous coronary interventions of the target vessel were successfully performed. In group 2, very good operative results were observed. In 1 and 6 months of follow-up, all patients remained asymptomatic. Critical stenosis of the left internal thoracic artery-LAD anastomosis was angiographically documented in 1 case (2%). This patient was successfully treated with balloon angioplasty.
  
  
  CONCLUSIONS
  The study results document the superiority of endoscopic atraumatic coronary artery bypass grafting over direct primary stenting in LAD revascularization, along with the slightly higher costs of the surgical procedure.
authors.affiliation: First Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland. marek.cisowski@cardiosurg.pl
authors.forename: Marek
authors.initials: M
authors.lastname: Cisowski
authors.forename: Janusz
authors.initials: J
authors.lastname: Drzewiecki
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Drzewiecka-Gerber
authors.forename: Andrzej
authors.initials: A
authors.lastname: Jaklik
authors.forename: Wojciech
authors.initials: W
authors.lastname: Kruczak
authors.forename: Michal
authors.initials: M
authors.lastname: Szczeklik
authors.forename: Andrzej
authors.initials: A
authors.lastname: Bochenek
mesh_terms: D017023:Coronary Angiography; D023903:Coronary Restenosis; D023921:Coronary Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents; D013906:Thoracoscopy