[Coronary revascularization in diabetic patient: which approach to choose?]

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Diabetes is a significant risk factor for complex coronary artery disease (CAD).
• Diabetic patients often present with diffuse, calcified, and multivessel CAD, complicating revascularization strategies.
• Optimal treatment selection is crucial for improving outcomes in this high-risk population.

Purpose of the Study:

• To present two contrasting clinical cases of diabetic patients with multivessel coronary artery disease.
• To illustrate the decision-making process for revascularization strategies in complex diabetic CAD.
• To highlight the role of intracoronary imaging and surgical revascularization in specific patient profiles.

Main Methods:

• Case report 1: Complex coronary angioplasty with intracoronary imaging for acute coronary syndrome and left main ostial lesions.
• Case report 2: Surgical revascularization (coronary artery bypass grafting) for stable extensive CAD with left ventricular dysfunction.
• Review of current guidelines and patient-specific factors influencing treatment choice.

Main Results:

• Coronary angioplasty guided by intracoronary imaging proved valuable for ostial left main lesions in an acute setting.
• Coronary artery bypass grafting demonstrated superiority in a stable patient with extensive CAD and impaired left ventricular function.
• Both cases underscore the need for tailored, multidisciplinary approaches.

Conclusions:

• Personalized and multidisciplinary strategies are essential for managing diabetic patients with complex CAD.
• Intracoronary imaging and coronary artery bypass grafting have distinct roles depending on patient presentation and anatomy.
• Emerging revascularization techniques and studies like ANDAMAN may further refine treatment standards for high-risk diabetic patients.