Which scenario is an indication to pursue coronary artery bypass grafting in addition to considering revascularization plans?

• A. Three-vessel disease
• B. Two-vessel disease without diabetes
• C. Single-vessel disease of the RCA
• D. No significant disease

Answer: (A)

Extent of disease drives the revascularization strategy. When there is three-vessel disease, all three major arteries have significant blockages, making complete revascularization more reliably achievable with bypass surgery. Coronary artery bypass grafting allows surgeons to bypass multiple obstructed segments with grafts, addressing diffuse atherosclerosis and supplying blood to all regions of the heart in one operation. This approach often provides more durable, long-term revascularization than attempting multiple separate stents, particularly in patients who may have complex anatomy or higher risk of restenosis.

Two-vessel disease without diabetes can be treated with either PCI or CABG depending on the exact lesion locations and patient factors, so it does not inherently mandate CABG. Single-vessel disease of the RCA is typically managed with PCI or surgery based on anatomy and comorbidity, not automatically requiring CABG. No significant disease clearly does not prompt consideration of CABG.

So, three-vessel disease is the scenario that most clearly indicates pursuing CABG in addition to planning revascularization.