What does complete revascularization mean in 2021? - Definitions, implications, and biases
Katsuhiro Hosoyama1, Kay Maeda, Yoshikatsu Saiki
1Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Insights
Complete revascularization (CR) is ideal for coronary artery disease, but incomplete revascularization (ICR) may be acceptable. Fractional flow reserve guidance can optimize revascularization strategies, especially for high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) management often involves revascularization.
- The long-term impact of incomplete revascularization (ICR) versus complete revascularization (CR) remains debated.
- Optimizing revascularization strategies is crucial for patient outcomes.
Purpose of the Study:
- To review the current evidence and concepts of CR and ICR in coronary artery disease.
- To discuss the implications of CR versus ICR on long-term patient outcomes.
- To explore future perspectives in revascularization strategies.
Main Methods:
- Review of existing literature on complete and incomplete revascularization.
- Analysis of studies comparing outcomes of CR and ICR.
- Discussion of current and emerging assessment techniques.
Main Results:
- Complete revascularization is generally desirable when achievable.
- Incomplete revascularization can be a reasonable alternative, balancing risks and benefits.
- Fractional flow reserve (FFR) guidance may help identify appropriate revascularization targets and refine strategies.
Conclusions:
- The debate on CR versus ICR continues, with ICR being a viable option in certain scenarios.
- FFR-guided revascularization can improve the appropriateness of interventions.
- Hybrid revascularization strategies, guided by FFR, show promise, particularly for high-risk patients.
Purpose Of Review:
Coronary revascularization is known to be an excellent treatment for coronary artery disease. However, whether incomplete myocardial revascularization compromises long-term outcomes, as compared to complete revascularization (CR), remains contentious. Herein, we review the concept of and evidence on CR/incomplete revascularization (ICR) and discuss future perspectives.
Recent Findings:
When possible, achieving CR in coronary artery bypass grafting is desirable; nonetheless, ICR is also a reasonable option to balance the therapeutic benefits against the risks.
Summary:
Although angiography-based assessment currently remains the standard of care, fractional flow reserve guidance may reduce the number of lesions requiring revascularization, which may be helpful for an appropriate surgical revascularization strategy. In particular, utilizing this approach may refine hybrid revascularization procedures, especially among high-risk patients.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care