Multivessel coronary artery disease (CAD): Coronary bypass surgery versus coronary angioplasty

With jeopardized viable myocardium in the distributions of the left anterior descending and right coronary arteries, it was decided to perform bypass surgery. Saphenous venous bypass grafts were placed to the left anterior descending, right and obtuse marginal coronary arteries. The patient had an uneventful postoperative course and was discharged. The case shows how nuclear myocardial perfusion imaging can be a useful adjunct in the clinical decision-making process when coronary anatomy reveals occlusion of one or more arteries associated with severe regional wall motion abnormalities suggesting scar. In this case, if only the angiographic and echocardiographic data had been evaluated, the inferior wall would have been assessed as nonviable and might not have been revascularized. The perfusion imaging, however, clearly defined persistent jeopardized viable myocardium involving the inferior wall as well as in the left anterior descending artery territory. This allowed the patient to have complete revascularization.