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Volume 15
Issue 12
10.3390/jcm15124813
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Review

The First and Final Answer: Left Internal Thoracic Artery-to-Left Anterior Descending Artery Bypass and the Reappraisal of Coronary Revascularization

by
Katsuhiko Oda
*,
Makoto Takahashi
,
Ryuichi Taketomi
,
Kota Itagaki
,
Takehiro Sato
and
Shintaro Katahira
Department of Cardiovascular Surgery, Iwate Prefectural Central Hospital, Morioka 020-0066, Japan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(12), 4813; https://doi.org/10.3390/jcm15124813 (registering DOI)
Submission received: 27 May 2026 / Revised: 15 June 2026 / Accepted: 19 June 2026 / Published: 21 June 2026
(This article belongs to the Special Issue Coronary Artery Bypass Grafting: Contemporary Clinical Research Update)
Versions Notes

Abstract

Medical intervention for ischemic heart disease began approximately 150 years ago with nitrates, and for nearly a century thereafter, little fundamental progress was made. With the advent of the left internal thoracic artery to the left anterior descending artery (LITA-LAD) bypass in the 1960s, treatment entered a new stage; however, its essential significance remained insufficiently recognized for many years. Numerous studies were subsequently conducted to evaluate alternative or parallel treatment strategies, but these investigations also helped bring the durable capacity of LITA-LAD to perfuse ischemic myocardium into sharper focus. Over the past quarter century, the treatment of ischemic heart disease has remained in a state of uncertainty, and its central prognostic foundation has often been obscured, although in recent years this uncertainty has begun to resolve. In this review, we reexamine the historical process by which the significance of LITA-LAD remained incompletely appreciated in parts of the cardiology and cardiac surgical communities. We further outline how the principal basis of the long-term prognostic benefit conferred by LITA-LAD gradually became evident and define the contemporary roles of medical therapy and percutaneous coronary intervention in relation to LITA-LAD-based coronary artery bypass grafting (CABG).
Keywords: ischemic heart disease; coronary artery bypass grafting; left internal thoracic artery; left anterior descending artery; medical therapy; percutaneous coronary intervention; coronary revascularization; total graft flow plateau; complete revascularization; myocardial perfusion ischemic heart disease; coronary artery bypass grafting; left internal thoracic artery; left anterior descending artery; medical therapy; percutaneous coronary intervention; coronary revascularization; total graft flow plateau; complete revascularization; myocardial perfusion

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MDPI and ACS Style

Oda, K.; Takahashi, M.; Taketomi, R.; Itagaki, K.; Sato, T.; Katahira, S. The First and Final Answer: Left Internal Thoracic Artery-to-Left Anterior Descending Artery Bypass and the Reappraisal of Coronary Revascularization. J. Clin. Med. 2026, 15, 4813. https://doi.org/10.3390/jcm15124813

AMA Style

Oda K, Takahashi M, Taketomi R, Itagaki K, Sato T, Katahira S. The First and Final Answer: Left Internal Thoracic Artery-to-Left Anterior Descending Artery Bypass and the Reappraisal of Coronary Revascularization. Journal of Clinical Medicine. 2026; 15(12):4813. https://doi.org/10.3390/jcm15124813

Chicago/Turabian Style

Oda, Katsuhiko, Makoto Takahashi, Ryuichi Taketomi, Kota Itagaki, Takehiro Sato, and Shintaro Katahira. 2026. "The First and Final Answer: Left Internal Thoracic Artery-to-Left Anterior Descending Artery Bypass and the Reappraisal of Coronary Revascularization" Journal of Clinical Medicine 15, no. 12: 4813. https://doi.org/10.3390/jcm15124813

APA Style

Oda, K., Takahashi, M., Taketomi, R., Itagaki, K., Sato, T., & Katahira, S. (2026). The First and Final Answer: Left Internal Thoracic Artery-to-Left Anterior Descending Artery Bypass and the Reappraisal of Coronary Revascularization. Journal of Clinical Medicine, 15(12), 4813. https://doi.org/10.3390/jcm15124813

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