In diffuse coronary artery disease, particularly in diabetes, will patients do better with coronary artery bypass grafting. It is an open heart surgery. Or they have 5 or more coronary stents placed in a minimally invasive interventional procedure. How to compare open heart surgery with coronary artery stenting for coronary artery disease therapy? Dr. Anton Titov, MD. Open-heart coronary artery bypass grafting surgery? Or percutaneous coronary artery stenting in patients with coronary artery disease? Dr. Anton Titov, MD. Who benefits most from which approach? Dr. Jeffrey Popma, MD. The decision algorithm for patients to receive coronary artery bypass surgery or multi-vessel coronary stenting is difficult. It is a discussion that will continue to be ongoing for many years. Dr. Jeffrey Popma, MD. We have done since 1991 randomized trials with balloon angioplasty and with coronary artery stents. The one theme that has come out in general from all of these trials is that. The more diffuse coronary artery disease likely does better with complete coronary revascularisation. Particularly in the presence of diabetes. Dr. Anton Titov, MD. That is likely better performed by a coronary artery bypass grafting surgery than with coronary stenting. That is a very important message. Dr. Jeffrey Popma, MD. Sometimes we look at patients and we say this. This is going to require 6 coronary stents or more or 5 coronary artery stents or more. Dr. Anton Titov, MD. Then we start to think about maybe the patient would be better served if they had a left internal mammary artery, LIMA, to left anterior descending artery surgical bypass grafting, CABG. Dr. Jeffrey Popma, MD. Then veins or other conduits to the other vessels are placed to provide complete revascularisation. Now of course, the downside is that the stroke risk in some but not all studies has been higher with coronary artery bypass grafting surgery. Not in all studies but in some. Recovery times are a little bit longer. Dr. Anton Titov, MD. You get one operation because we have really not gone back to a redo coronary artery bypass operation. Dr. Jeffrey Popma, MD. We have come up with alternative methods for our coronary artery stenting procedures instead. Part of that is CHIP. It is Complex High-risk Interventional Procedures. It is the category of coronary artery disease we have talked about before. What I look at now is this. The patient may have diabetes, very diffuse coronary artery disease. Then they are going to require five or six coronary stents or more to provide a good result. The patient may have a low cardiac ejection fraction. Then this patient may benefit from complete revascularisation. Coronary Artery Bypass Graft surgery is better for this patient. Dr. Jeffrey Popma, MD. Multiple total coronary artery occlusions are treatable many times if the distal target vessel is good. Although my partners might argue with me about whether multiple total coronary artery occlusions can be treated well. It is not not such a bad idea to go after that with coronary artery bypass grafting surgery. Dr. Anton Titov, MD. It is better than performing a transcatheter coronary artery stenting therapy.