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J Thorac Cardiovasc Surg 2009;137:1020-1021
© 2009 The American Association for Thoracic Surgery

Brief Communication

Coronary stent disease: When will enough be enough?

Igor E. Konstantinov, MD, PhD*, Pankaj Saxena, MCh, DNB, Jaffar Shehatha, FRCS, FRACS

Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, University of Western Australia, Perth, Australia

Received for publication March 31, 2008; accepted for publication April 13, 2008.

* Address for reprints: Igor E. Konstantinov, MD, PhD, Associate Professor of Surgery, University of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Perth, WA 6009, Australia. (Email: konstantinov.igor@alumni.mayo.edu).

The first 20% of the full text of this article appears below.

Drug-eluting stents significantly modify and often complicate the natural history of coronary artery disease. This report emphasizes that every patient with multivessel coronary artery disease must be reviewed by a surgeon and properly informed before stenting.

Clinical Summary

A 60-year-old man was transferred to the Sir Charles Gairdner Hospital with unstable angina. His comorbidities were obesity (body mass index 33.6 kg/m2), hypertension, type II diabetes mellitus requiring insulin, hypercholesterolemia, and chronic renal failure (creatinine 150 mmol/L) due to diabetic nephropathy. The patient was an ex-smoker. Left ventricular ejection fraction was 45% with hypokinesis of the inferolateral wall. He had severely diseased left anterior descending (LAD) and left circumflex (LCx) coronary arteries with multiple in-stent stenoses (Go Figure 1) and a small nondominant right coronary artery.


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  		Figure 1. Multiple stents in the LAD, OM, and terminal branches of the LCx coronary artery (A), with significant in-stent stenosis . . . [Full Text of this Article]

 





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