Competitive Coronary Flow between the Native Left Anterior Descending Artery and Left Internal Mammary Artery Graft: Is It a Surrogate Angiographic Marker of Over-or-Unnecessary Revascularization Decision in Daily Practice?

Competitive Flow: Closure of Internal Thoracic Artery Graft After Successful Coronary Artery Bypass Graft Surgery

The internal thoracic artery has a patency rate of 85%-95% at 10-15 years post coronary artery bypass graft surgery. Development of total occlusion of the internal thoracic artery within a short period (< 6 months) after the surgery is exceedingly rare. However, competitive flow between the native vessel and the conduit internal thoracic artery, or competitive flow between the 2 conduit internal thoracic arteries in a multiple arterial grafting procedure can jeopardize 1 of the 2 conduit internal thoracic arteries. We report the cases of 2 patients who had bilateral internal thoracic artery grafts, with total occlusion of 1 of the 2 grafts within a short period (6 months) after successful coronary artery bypass graft surgery.

Palliative treatment of coronary "atherosclerotic cancer" by drug-eluting or bare-metal stents: From oculo-stenotic reflex period to age of precision medicine

Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease such as atherosclerosis or cancer. Some authors speculated that atherosclerotic coronary artery disease (CAD) could be considered a "cancer of the coronary arterial wall". Although the percutaneous coronary intervention (PCI) has proven to be effective in decreasing mortality rates among patients with acute coronary syndromes, the previous meta-analyses of PCI versus optimal medical therapy for stable CAD have not been able to demonstrate a reduction in major adverse cardiac outcomes. However, few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. Recently, the precision medicine is defined as an evidence-based approach that uses innovative tools and biological and data science to customize disease prevention, detection, and treatment, and improve the effectiveness and quality of patient care. Providing patients with accurate and complete information appears to be an effective way to combat the reliance on the oculostenotic reflex. The foundation of precision medicine is the ability to tailor therapy based upon the expected risks and benefits of treatment for each individual patient. As said by Doctor William Osler, "The good physician treats the disease; the great physician treats the patient who has the disease."