Diabetic patient with three-vessel disease and left main involvement. Surgery yes, but not always

AbstractCoronary artery disease (CAD) is known to be the main cause of morbidity and mortality in patients with diabetes mellitus. Although they do not often show typical recognized symptoms, diabetic patients suffer from more extensive CAD and hence higher incidence of multi-vessel CAD than in non-diabetic subjects. Literature has given the strength of evidence in favor of surgical revascularization in diabetic patients with multi-vessel disease. We report the case of a 61-year old active smoker and diabetic man with atypical symptoms and positive treadmill test. The coronary angiography revealed a severe three-vessel disease and distal left main involvement (SYNTAX score=49). As the patient refused to follow heart team indication to undergo coronary bypass grafting, a percutaneous coronary intervention was successfully performed with intra-aortic balloon counterpulsation support and intravascular ultrasound optimization. The mid-term outcome was good

Secondary prevention after an acute cardiovascular event: far from targets and large room for improvement

International audienc

Dissecting the epidemiology of aortic dissection

International audienc

Invasive assessment modalities of unprotected left main stenosis

AbstractAmong all coronary lesions, the decision-making process for the treatment of unprotected left main (ULM) stem lesions is still challenging. Indeed, the optimal therapeutic strategy for patients with ULM disease remains controversial: coronary artery bypass grafting was established as the gold standard, but it is without doubt that percutaneous coronary intervention (PCI) performed by experienced operators achieves good results at long term follow up, especially in cases where the ostium and/or shaft of ULM are treated. Thanks to the widespread use of invasive assessment of atherothrombotic ULM stenosis, improved selection of PCI cases and techniques of stenting, better outcomes are now possible. This review seeks to define the place of PCI in ULM disease by describing the different modalities of ULM stenosis assessment