Left dominant circulation with proximal LAD disease. should we be even considering CABG as the initial strategy?

Abstract

According to the ESC (European society of cardiology) guidelines,1 both PCI(Percutaneous coronary intervention) and CABG (Coronary artery bypass grfting) have been given ‘Class I’ status for management of critical lesions in proximal LAD (Left anterior descending) artery in diabetic patients. CABG has been known to cause accelerated atherosclerosis of the native vessels proximal to the graft-native vessel anastomosis site. In Left dominant circulation, accelerated atherosclerosis can increase the risk of myocardial ischemia and re-intervention.We present such a case to discuss the issues pertaining to this subgroup and the management strategies.

Keywords

• Left dominant circulation
• Proximal LAD stenosis
• Revascularisation