title: Multiple extensive coronary artery stenting: does it compromise future surgical revascularization?
abstract: OBJECTIVE
  In the era of percutaneous coronary intervention, surgeons are confronted with performing coronary artery bypass graft surgery on patients with previous balloon dilatation or stenting. This review evaluates the impact of previous percutaneous coronary intervention on patient survival and choice of optimal myocardial revascularization technique.
  
  
  RESULTS
  Aggressive atherosclerosis has been remarked in patients complicated with intrastent stenosis. Moreover, bypass grafting with venous grafts has shown an extremely high incidence of graft failure in the restenosis population due to limited nitric oxide (a natural vasodilator) production of venous grafts. The challenge is to achieve complete revascularization in an unfavourable setting (greater co-morbidities, complex coronary lesions) with a greater risk of graft occlusion.
  
  
  CONCLUSIONS
  The internal thoracic artery is the optimal graft for myocardial revascularization in patients with and without previous in-stent restenosis. Coronary artery reconstruction by exclusive internal thoracic artery grafting gives superior patency rates and clinical outcomes. It is the most appropriate approach for myocardial revascularization in these patients.
authors.affiliation: Department of Cardiac Surgery, Bichat Hospital, Paris, France.
authors.forename: Nawwar
authors.initials: N
authors.lastname: Al-Attar
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
mesh_terms: D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D023903:Coronary Restenosis / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D006801:Humans; D009204:Myocardial Revascularization / Q000401:mortality; D015607:Stents; D016896:Treatment Outcome