**9. Future study with the second generation des and other bioabsorbable stents**

EXCEL is a 2600-patient study comparing patients with left main disease randomized to bypass surgery or PCI with the Xience stent and followed for at least three years. The primary end point is death, stroke, and MI; repeat revascularization is a secondary end point. EXCEL results awaited. Figure (8)

metallic stents, there are several potential advantages, including complete absorption of stent material, [24], Abbott Vascular ABSORB Everolimus Eluting Bioresorbable Vascular Scaffold System"These outcomes suggest that a temporary scaffold like ABSORB provides durable re‐ sults over the long term and a permanent implant may not be necessary to effectively treat pa‐

Artery Bypass Versus PCI Using New Generation DES

http://dx.doi.org/10.5772/54029

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**10. Combining the best of both worlds hybrid coronary revascularization**

As PCI technology improves and techniques of LIMA-to-LAD grafting become less invasive, hybrid coronary revascularization is becoming a distinct possibility. For example, a minimally invasive, off-pump, direct LIMA-to-LAD anastomosis can be combined with DES placement in a focal mid-right-coronary-artery lesion in a patient with complex proximal LAD lesions. Hybrid coronary revascularization procedures are currently being performed, with promising early results. A few centers, now have hybrid operating rooms with cardiac surgical and coronary angiographic capabilities that make it possible to perform simultaneous hybrid coronary revascularizations. Staged hybrid revascularizations are performed in standard

Each strategy can have great outcomes in appropriately selected patients. Hard clinical outcomes (death/MI/CVA) are generally similar, need to weigh the risk of potential repetition of procedures with PCI using DES vs. the greater morbidity of CABG. The 3VD and LMCA Disease are high-risk coronary lesions and the least stable subtypes of "stable CAD" PCI and CABG have very similar rates of hard clinical endpoints. Greater rates of recurrent revascu‐ larization with PCI, especially in complex disease, Patient selection and patient preference will generally dictate the best and most appropriate care. The so-called SYNTAX score, evolved for the trial, offers a grading system, based on patient anatomy, to help surgeons and inter‐ ventionalists make this decision. As PCI and CABG are refined further, surgeons and cardi‐ ologists will no doubt learn to use these improved interventional techniques and surgical

King Saud Bin Abdulaziz University for Heath Sceinces, KACC, National Guard , Riyadh,

procedures in a way that will optimize the treatment of each individual patient.

tients with coronary artery disease". ABSORB II trial is ongoing. Figure (9)

catheterization laboratories and operating rooms. [25,26].

**11. Conclusion**

**Author details**

Saudi Arabia

Mohammed Balghith

**Figure 8.** EXCEL study protocol comparing Xience stent with CABG

**Figure 9.** Absorb Stent- Bioabsorbale everolimus eluted stent

Stents composed of bioabsorbable/biodegradable materials represent an attractive alternative revascularization modality; the justification stems from the short-term need for vessel scaffold‐ ing and avoidance of the potential long-term complications of metallic stents. Compared with metallic stents, there are several potential advantages, including complete absorption of stent material, [24], Abbott Vascular ABSORB Everolimus Eluting Bioresorbable Vascular Scaffold System"These outcomes suggest that a temporary scaffold like ABSORB provides durable re‐ sults over the long term and a permanent implant may not be necessary to effectively treat pa‐ tients with coronary artery disease". ABSORB II trial is ongoing. Figure (9)
