Can we advice CABG for single vessel disease ?
Yes, CABG may be indicated in
- Critical , proximal , complex LAD disease with or without ostium involvement.
- Many of the bifurcation lesions with large and significant side branch
- Small caliber LAD with diffuse disease .
When these occur in diabetic subjects , the indication for CABG is more certain .
* Present generation cardiologists would feel every lesion is stentable and should not be referred to the surgeon .But it should be emphasized here, technical feasibility alone , does not imply PCI is superior and ideal in all coronary interventions.
Can we do a CABG in single vessel disease with normal LAD ?
CABG is very rarely indicated for isolated RCA or LCX disease. It should be consciously avoided in this patient population.
This is because the at risk myocardium supplied by these vessels are far less than that of LAD. PCI is preferred in these vessels .(Ofcourse , after considering medical management ) .
CABG is , too traumatic a surgery , to offer in this low risk coronary lesions.
Exceptions
CABG can still be done in following situations for non LAD single vessel disease.
- Left dominant circulation with complex lesions in LCX /OMs.
- It is common to see diffuse , long segment and severe disease of RCA with normal LAD /LCX system .PCI is not feasible in this subset.
- Failed PCI
- Recurrent instent restenosis.
- Bail out CABG after a acute complication during PCI
One should remember , inability to do a PCI does not mean , the patient should land in surgeon’s table .We should recall , from our memory medical management is an effective and established form of treatment in single vessel disease ( Mainly for non LAD , and some cases of LAD also !)
Dr.S.Venkatesan MD 