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Diabetes and Percutaneous Interventional Therapy

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Diabetes and Cardiovascular Disease

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

The increased morbidity and mortality associated with diabetes are strongly driven by atherosclerosis; a process more advanced within the diabetic population. Furthermore, atherosclerosis can occur anywhere within the arterial system and frequently, in diabetic patients, affects not only the coronary arteries but also the peripheral arteries. The treatment of atherosclerosis can be divided into both medical and procedural therapies. The medical therapy for atherosclerosis, and namely coronary artery disease, is fairly well established and protocolized. Unfortunately, the decision tree to proceed with interventional therapy, and what type of intervention, is more complex both within the coronary and peripheral systems. Management of diabetic coronary artery disease will always include guideline-directed medical therapy. Beyond that, the decision to intervene with a percutaneous coronary intervention (PCI) versus proceeding with coronary artery bypass grafting (CABG) is strongly determined by the severity/complexity of coronary artery disease. Based on the anatomy of the coronary arteries (left main involvement, SYNTAX score), diabetic patients frequently derive a mortality benefit from CABG, whereas the nondiabetic patient would not receive that same benefit.

Diabetic patients historically have more advanced and severe peripheral arterial disease (PAD) than their nondiabetic cohort. Historically, it was thought that diabetic patients had higher rates of 1-year major amputation or mortality post-endovascular treatment of PAD but more recent studies show no significant difference. That said the long-term success of endovascular or open surgical treatment of advanced PAD is disappointing. In recent years, the development of drug-coated or drug-eluting balloons and stents treated with an anti-proliferative medication has proven to extend the benefits of interventional therapy. Lastly, over the past two decades, endovascular atherectomy device technologies have advanced greatly and are now shown to extend the benefit of and have become a major component of endovascular PAD treatment.

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  1. Department of Cardiovascular Medicine, St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA

    Gerard H. Daly, Mohamed Abdelazeem, Lawrence A. Garcia & Joseph P. Carrozza Jr

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Daly, G.H., Abdelazeem, M., Garcia, L.A., Carrozza, J.P. (2023). Diabetes and Percutaneous Interventional Therapy. In: Johnstone, M., Veves, A. (eds) Diabetes and Cardiovascular Disease. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-031-13177-6_25

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