Management of Diffuse Coronary Artery Disease with an Overview of Recent Trials

Diffuse coronary artery disease (CAD) is defined as a coronary lesion >20 mm in length, with pressure wire pullback revealing a progressive, gradual decrease in pressure in the diseased segment, without an abrupt pressure drop. Diffuse CAD influences catheter derived physiological indices which, in turn, determine percutaneous coronary intervention (PCI) outcomes. Intracoronary imaging though costly and time consuming is useful for the accurate assessment of pre-PCI coronary morphology and for PCI optimization. Diffuse CAD is considered a difficult challenge for coronary stenting because the lesion length is an important predictor of restenosis. Drug coated balloons are good alternatives for drug eluting stents in diffuse lesions. Even after what seems as successful PCI by angiography, physiological studies may show suboptimal findings in diffuse disease. Stents and surgery may also be associated with incomplete revascularization. Better surgical techniques, improved hybrid strategies, and stem cell therapy may hold great promise in the future.