Prof Mario Mazilli, University of Pisa, Italy

Mario Mazilli, Professor of Cardiovascular Medicine, Medical School & Director of the Cardiovascular Diseases School of Specialization, University of Pisa, Italy, talked to Cardio Debate about the role of coronary artery stenosis in ischaemic heart disease.

Coronary artery stenosis: Culprit or bystander?
I believe that in the vast majority of patients with ischaemic heart disease, coronary atherosclerotic obstruction are just bystanders. The reason why I am making this statement is because in the vast majority of patients with ischaemic heart disease there is no significant coronary stenosis.

And because there is overwhelming evidence that in the vast majority of patients that do have a coronary atherosclerotic obstruction there will never be lifelong ischaemic heart disease.

What are the most common reasons for recurrent angina after angioplasty and stenting?
Of course, based on what I’ve just said, because angioplasty does not touch the real mechanics of ischaemia in many patients. If we assume, or accept the idea that ischaemic heart disease is a multifactorial condition, where a number of different of mechanisms may contribute to precipitate myocardial ischaemia, including coronary vasospasm, microvascular dysfunction, inflammation, endothelial dysfunction, platelet dysfunction – it’s a very long list.

So it’s quite understandable that just removing the obstruction in many patients, as has been recently acknowledged by the guidelines, that the problem is untouched.