INTERVENTION AND MANAGEMENT OF MULTIVESSEL DISEASE IN DIABETES

Diabetes has established itself as the pandemic of the 21st century. In 1985, an estimated 30 million people worldwide had diabetes; by 2003, it was estimated that there were approximately 194 million people with diabetes, with this figure expected to rise to almost 350 million by 2025. There are several pathophysiological mechanisms in diabetes that contribute to increased morbidity and mortality rates. The underlying defect of insulin resistance seen in >90% of type 2 diabetic patients is associated with hyperglycemia, dyslipidemia, inflammation, and hypercoagulability. Eighty percent of all deaths among diabetic patients are due to atherosclerosis, compared with approximately 30% among nondiabetic persons. The nature and distribution of atherosclerosis in diabetes also portends a poorer prognosis and response to revascularization. Diabetic patients have a larger burden of disease, a greater proportion of lipid- and macrophage-rich plaques, more fissured plaque, and more intracoronary thrombi. Multivessel disease (MVD), left main involvement, chronic total occlusions, and diffuse disease are seen frequently. Diabetic patients have an impaired ability to develop collaterals in response to atherosclerosis Therefore, physicians perform endovascular revascularization to make a better prognosis for the patient with multivessel disease

 

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