CABG is typically considered when PCI is not possible due to what condition?

• A. Extensive ischemia.
• B. Patient refusal of surgery.
• C. Shortness of breath.
• D. Mild chest discomfort.

Answer: (A)

Extent of disease and the resulting amount of myocardium at risk is what drives this decision. When ischemia is extensive, many arteries are blocked or there is complex multivessel disease that cannot be reliably or safely cured by blocking a few individual lesions with PCI. CABG provides a way to bypass multiple blocked arteries at once, giving blood flow to large coronary territories in a more durable way, which is why it’s considered when PCI isn’t feasible due to extensive ischemia. The other scenarios—patient declining surgery, or symptoms like shortness of breath or mild chest discomfort—do not address the need for revascularization strategy in the same way and don’t reflect PCI infeasibility from anatomy or extent of disease.