Stratégies innovantes pour revasculariser les patients avec maladie coronarienne complexe

 

Stéphane Rinfret

Institut universitaire de cardiologie et de pneumologie de Québec

 

Domaine : santé circulatoire et respiratoire

Programme chercheurs-boursiers cliniciens - Senior

Concours 2015-2016

Atherosclerosis causes blockages in the arteries of the heart, or coronary arteries.  When several blockages are identified, coronary artery bypass graft (CABG) surgery rather than angioplasty with stents will be recommended.  CABG remains a more invasive procedure, requiring several months of recovery and at increased risk of mortality.  It is desirable to identify those patients with several coronary blockages who may be better candidate for CABG, and those who could rather be managed with angioplasty and drug-eluting stents. 

Given that the surgeon needs to attach a graft on the artery, this artery needs to be relatively healthy at the segment where the graft is put.  I want to improve our pre-operative evaluation of the future sites of coronary bypass to predict if the surgeon will be able to do it or not, and if the graft is at risk of early occlusion following surgery.  Our evaluation could avoid unnecessary surgeries.  Moreover, when blockages are complete, surgeons have a harder time to attach grafts. However, new techniques of angioplasty allow for an effective reopening of those complete occlusion in more than 90% of those patients.  We will then assess if those less invasive techniques do better than CABG surgery for treatment of chronic total occlusions of the coronaries.  Finally, the use of one leg vein as a conduit for CABG is associated with poor long-term outcomes, with more than haft of these conduits that occlude within 10 years.  On the other hand, the use of thoracic arteries is associated with excellent long-term evolution, those arteries staying open almost forever. 

We therefore want to test an innovative approach combining surgery with the use of thoracic arteries and angioplasty with drug-eluting stents instead of using vein grafts.  My programme is therefore aimed at improving healthcare delivery to patients with complex coronary artery disease.