From the Guidelines
Severe arterial stenosis is typically treated with revascularization procedures, such as Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG).
Treatment Options
- PCI is the preferred approach for patients with 1- or 2-vessel disease, especially if angioplasty of 1 or more lesions has a high likelihood of initial success 1.
- CABG is often preferred for patients with left main coronary disease, those with reduced LV systolic function, or those with severe 3-vessel stenosis 1.
Patient Selection
- High-risk patients, such as those with unstable angina or non-ST-segment elevation myocardial infarction (NSTEMI), should be considered for early revascularization 1.
- Low-risk patients may be treated with maximal medical therapy, and revascularization can be considered if symptoms persist or quality of life is poor 1.
Important Considerations
- Women with acute coronary syndrome (ACS) may have different treatment outcomes compared to men, and treatment decisions should be individualized based on patient preferences and risk factors 1.
- Comorbidities, such as advanced malignancy, intracranial pathology, or end-stage cirrhosis, may preclude revascularization, and treatment decisions should be made on a case-by-case basis 1.
From the Research
Treatment Options for Severe Arterial Stenosis
The treatment for severe arterial stenosis, specifically severe aortic stenosis (SAS), involves various approaches, including:
- Surgical aortic valve replacement (SAVR)
- Transcatheter aortic valve replacement (TAVR)
- Percutaneous coronary intervention (PCI)
- Coronary artery bypass grafting (CABG)
Comparison of Treatment Outcomes
Studies have compared the outcomes of different treatment approaches, including:
- PCI + TAVR vs CABG + SAVR, with results showing that PCI + TAVR may be associated with lower mortality and stroke rates at 1 year 2
- TAVR vs medical therapy in inoperable patients, with evidence supporting TAVR 3
- TAVR vs SAVR in high-risk patients, with equal outcomes observed in all-comer intermediate-risk populations 3
Decision-Making Process
The decision-making process for treating severe arterial stenosis involves a collaborative approach between physicians and surgeons, known as the Heart Team, to determine the best treatment strategy for each patient 4, 3. Factors such as patient age, comorbidities, and disease severity are taken into account when making treatment decisions.
Contemporary Management
Contemporary management of severe arterial stenosis has evolved, with TAVI offering a less invasive option for treatment 3. The learning curve associated with TAVI has improved, and overall complication rates have decreased. Geriatric assessment is useful for identifying preoperative frailty, a major risk factor for death post-aortic valve intervention 3.
Treatment Approaches for Specific Patient Groups
For patients with concomitant coronary artery disease (CAD) and SAS, treatment approaches include: