Stent oder MIDCAB? – Therapie der isolierten proximalen LAD–Stenose

Die isolierte proximale left anterior descending (LAD) Koronararterienstenose ist von prognostischer Relevanz und bei der Revaskularisation mittels perkutaner Koronarintervention (PCI) oder Bypassoperation ergeben sich spezifische Besonderheiten. In der vorliegenden Übersicht werden beide Revaskularisationsverfahren, die PCI mit Stents und die minimal invasive direkte Bypasschirurgie (MIDCAB–OP) beschrieben sowie die derzeitige Datenlage beleuchtet. Während die PCI mit Bare–Metal–Stents in Bezug auf erneute Zielgefäßrevaskularisationen der MIDCAB–OP bei gleichen Ergebnissen für Vermeidung von Tod oder Myokardinfarkt unterlegen war, konnten mit Einführung von Drug–eluting–Stents für die PCI vergleichbare Ergebnisse zur MIDCAB–OP erreicht werden.

Isolated proximal left anterior descending (LAD) coronary artery stenosis is of prognostic relevance and proximal stenosis location carries specific specialties for revascularization either by percutaneous coronary intervention (PCI) or coronary artery bypass grafting. In the following overview both revascularization strategies, PCI plus stenting and minimally invasive direct coronary artery bypass grafting (MIDCAB) are described. In addition, the current evidence is reviewed. PCI plus bare–metal stenting was inferior to MIDCAB surgery with respect to target vessel revascularization rates with similar results for freedom from death and infarction. Since the introduction of drug–eluting stents similar results can be obtained with PCI in comparison to MIDCAB surgery.

Key words

Atherosclerosis - bypass - coronary artery disease - restenosis - drug–eluting stents - coronary artery disease

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