Coronary Artery Revascularisation : Past, Present and Future

The high prevalence of coronary artery disease has inspired the development of technologies and techniques for coronary revascularisation, including coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI). PCI have witnessed the impact of innovation with newer hardware and drug eluting stents (DES). DES have indisputably reduced restenosis, however there is an emerging concern over the risk of late stent thrombosis associated with their use. We discuss the limitations of the current generation DES and review advances in the stent technology. The technology used in CABG has improved, resulting in off-pump coronary artery bypass (OPCAB), endoscopic, video-assisted, and robot-assisted CABG with automated one-shot distal anastomotic devices being used increasingly. The difference in adverse outcomes between CABG and PCI continues to decline and the future may witness a close collaboration between the two.