Chakraborty R
Apollo Hospitals, Hyderabad.
J Indian Med Assoc. 1999 Jul;97(7):271-5.
Revascularisation is the main principle of treatment of obstructive coronary artery disease. This technique is available either by catheter intervention like angioplasty or by-pass surgery. The superiority of one over the other is still undetermined. In symptomatic single vessel disease angioplasty may be a better option than by-pass surgery. In two-vessel coronary artery disease angioplasty may also be preferred especially with good left ventricular function. In patients with double-vessel disease particularly involving proximal left anterior descending artery in association with diabetes mellitus surgery has better long term results. In multivessel disease by-pass surgery is a preferred option although initial results of angioplasty in this group may be very satisfactory. The incidence of further intervention either by surgery or repeat angioplasty is high in patients undergoing angioplasty in multivessel disease. Left main stem disease should be dealt with by-pass surgery. With continued advancement in the revascularisation technology of coronary artery disease both in catheter intervention and surgical fronts there is no room for unequivocal or universal strategy plan in the management of coronary artery disease. Both the techniques are complimentary to each other. Cost consideration is a major consideration in India. Choice should be made after proper evaluation of coronary anatomy, underlying clinical condition, local experience, social and especially economic circumstances.
血管重建是治疗阻塞性冠状动脉疾病的主要原则。该技术可通过导管介入（如血管成形术）或搭桥手术来实现。两者谁更具优势仍未确定。对于有症状的单支血管疾病，血管成形术可能是比搭桥手术更好的选择。对于双支血管冠状动脉疾病，尤其是左心室功能良好时，血管成形术也可能更受青睐。对于双支血管疾病患者，特别是累及左前降支近端并伴有糖尿病时，手术具有更好的长期效果。对于多支血管疾病，搭桥手术是首选方案，尽管该组患者血管成形术的初始效果可能非常令人满意。多支血管疾病患者接受血管成形术后，通过手术或重复血管成形术进行进一步干预的发生率很高。左主干疾病应通过搭桥手术治疗。随着冠状动脉疾病血管重建技术在导管介入和外科领域的不断进步，在冠状动脉疾病的管理中没有明确或通用的策略计划的空间。这两种技术相辅相成。成本考量在印度是一个主要因素。应在对冠状动脉解剖结构、潜在临床状况、当地经验、社会尤其是经济情况进行适当评估后做出选择。
