Can stent-angioplasty be a valid alternative to surgery when revascularization is indicated for anomalous origination of a coronary artery from the opposite sinus?
When intervention is indicated for anomalous origination of a coronary artery from the opposite sinus, stent-angioplasty may seem more attractive than coronary artery bypass grafting. However, in the case of anomalous origination of a coronary artery from the opposite sinus, the anatomy is quite different from that encountered in atherosclerotic disease, and stent-angioplasty would involve unusual challenges, both in technique and prognostic outcomes. We illustrate these points by presenting the 2 first cases in which intervention was indicated because of severe symptoms. We conclude from this preliminary study that coronary artery bypass grafting should still be considered the preferred (although unproven) method of revascularization in patients who have symptomatic anomalous origination of a coronary artery from the opposite sinus. Until adequate data have been gathered to evaluate the late results of stent-angioplasty in these patients (in comparison with the results of surgical and medical treatment), the procedure should be performed only in selected patients, enrolled in prospective, controlled studies.
Hariharan
Ramesh
R
Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Kacere
Richard D
RD
Angelini
Paolo
P
D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D015203:Reproducibility of Results; D012850:Sinus of Valsalva / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D015607:Stents; D018084:Ultrasonography, Interventional