Search Results (1,030)

Urban trees are increasingly deployed as nature-based infrastructure to mitigate heat and manage stormwater, yet quantitative guidance on how species traits and site context shape transpiration remains fragmented. We conducted a systematic metadata analysis of seven field studies that measured daily transpiration rate in urban settings using heat-pulse methods. The units and spatial scales reported were harmonized with the sap flow density across active sapwood (J_s, g H₂O/${\mathrm{cm}}^2$/day) by converting reported stand transpiration and the outer 2 cm of sapwood sap flux using established Gaussian radial distribution functions for angiosperms and gymnosperms, which account for the non-linear decline in sap flux from the vascular cambium to the heartwood boundary. We then summarized distributions and tested group differences with Kruskal–Wallis and Dunn post hoc comparisons across wood anatomy, climate, soil texture, and planting configuration. Conifers exhibited significantly lower median $J_s$ (39.76 g/${\mathrm{cm}}^2$/day) than angiosperms, while the ring-porous group (median $J_s$ = 92.25 g/${\mathrm{cm}}^2$/day) and diffuse-porous groups (median $J_s$ = 96.70 g/${\mathrm{cm}}^2$/day) had similar distributions overall. Climate-modulated responses within wood anatomy groups differed, with diffuse-porous species exhibiting the highest median $J_s$ (152.59 g/${\mathrm{cm}}^2$/day) in semi-arid regions, ring-porous species maintaining comparatively stable median $J_s$ across climates (varying slightly between 80.72 and 99.32 g/${\mathrm{cm}}^2$/day), and conifers reaching their highest median $J_s$ (69.90 g/${\mathrm{cm}}^2$/day) in humid continental sites. Soil texture effects were consistent with moisture availability: sandy loam generally reduced $J_s$ relative to loam or silt loam for conifers and diffuse-porous species. Across anatomies, single trees transpired more than clustered trees or closed canopies. For example, planting as single trees increased median $J_s$ by 86% in conifers (from 33.01 to 61.37 g/${\mathrm{cm}}^2$/day) and by 45% in diffuse-porous species (from 81.31 to 118.25 g/${\mathrm{cm}}^2$/day). These results provide actionable ranges and contrasts to inform species selection and planting design for urban greening and runoff reduction, while highlighting data gaps for future research. Ultimately, by matching specific wood anatomies and planting configurations to local soil and climatic conditions, urban planners and ecohydrologists can strategically optimize urban forests to maximize targeted ecosystem services. Full article

Background: A solid understanding of dental and craniofacial anatomy is essential for reliable clinical practice, yet long-term retention of anatomical knowledge is known to decline as students progress through their training. Although digital- and image-based resources are widely used in anatomy education, it remains unclear whether two-dimensional (2D) representations support durable recognition of complex anatomical structures. This study investigated whether tactile engagement with real three-dimensional (3D) anatomical specimens enhances long-term identification accuracy compared with standardized 2D images. Materials and Methods: Eighty-nine fifth-year dental students at the University of Oslo were assessed approximately 2.5 years after completing their formal anatomy course. All students completed two sequential identification tests on the same day: a 2D image-based test followed immediately by an equivalent test using real extracted human teeth and real skull bones. The assessments comprised 28 osteology structures and 14 teeth. Performance between conditions was compared using mixed-effects logistic regression with test modality as a fixed effect and participant and anatomical item as crossed random effects. Results: Overall identification accuracy increased from 52% in the 2D condition to 74% in the 3D tactile condition (p < 0.0001). Mean accuracy for osteology improved from 0.519 (SD = 0.074) to 0.708 (SD = 0.072) (p < 0.0001), while tooth morphology scores increased from 0.535 (SD = 0.097) to 0.795 (SD = 0.110) (p < 0.0001). All individual teeth and nearly all osteological structures showed significantly higher identification accuracy in the 3D condition. The largest gains were observed for structures with low 2D recognition. Conclusions: Tactile interaction with real 3D anatomical specimens substantially enhances long-term recognition of dental and craniofacial anatomy. These findings support the continued integration of hands-on, three-dimensional learning alongside digital resources in dental anatomy education to promote durable anatomical understanding and clinical preparedness. Full article

Background/Objectives: Ultra-low-profile (ULP) endografts have expanded the applicability of endovascular aneurysm repair (EVAR) in patients with challenging aortoiliac anatomy and narrow access vessels. However, direct long-term comparisons between different ULP devices remain limited. This study aimed to compare mid- to long-term outcomes of the INCRAFT and Ovation endografts in a single-center experience. Methods: This retrospective single-center study included 102 patients (45 Ovation, 57 INCRAFT) with a median follow-up exceeding 60 months. We retrospectively analyzed 102 consecutive patients undergoing elective EVAR with ULP devices between January 2011 and December 2019. Forty-five patients were treated with Ovation and 57 with INCRAFT. The primary endpoint was technical success. Secondary endpoints included survival, reintervention, endoleak, and device-related complications. Statistical comparisons were performed using Student’s t-test and Fisher’s exact test. Results: Primary technical success was achieved in all cases. The Ovation group exhibited more complex proximal neck anatomy, including greater thrombus involvement (47.4% vs. 12.7%, p < 0.001). Post-implantation syndrome occurred more frequently with INCRAFT (14% vs. 0%, p = 0.009). No significant differences were observed in endoleak, major adverse events, or total reintervention. Long-term mortality was higher in the Ovation group (37.8% vs. 15.8%, p = 0.01), although deaths were not aneurysm-related. Median follow-up exceeded 60 months in both groups. Conclusions: Both ULP endografts demonstrated favorable long-term outcomes within the limitations of a non-randomized, anatomically heterogeneous cohort. Full article

Background: Oral and cranio-maxillofacial (OCMF) surgery is a complex specialty that requires detailed anatomical knowledge and, in fracture care, the ability to interpret imaging accurately. Mixed reality (MR) may improve spatial understanding in anatomy-based disciplines, but its value for teaching mandibular fracture classification remains uncertain. Methods: Medical and dental students at the University of Zurich were randomized 1:1 to classify four unilateral mandibular fractures using either MR or conventional two-dimensional (2D) imaging. Primary outcomes were perceived usefulness, ease of use, learning, and user satisfaction, assessed with a 15-item usability questionnaire. Secondary outcomes were fracture-classification accuracy and time to fracture classification. Results: Forty medical and dental students were included. Baseline characteristics were comparable between groups, and overall fracture-classification accuracy did not differ significantly between MR and 2D. Both groups became faster across successive cases, indicating a learning effect, although the 2D group completed classifications more quickly overall. MR participants reported higher scores for learning and user satisfaction, whereas the 2D group rated ease of use more favorably. Conclusions: MR increased user satisfaction but did not improve fracture-classification accuracy compared with 2D imaging. When integrated thoughtfully into OCMF education, MR may complement, rather than replace, conventional imaging approaches. Full article

Background and Objectives: Fragmented anatomical, imaging, and surgical accounts of the gracilis muscle hinder reproducible reporting and operative planning. We aimed to integrate prior systems into an Integrated Gracilis Framework (IGF)—an integrative synthesis, not a new classification—that harmonizes terminology, defines imaging correlates/pitfalls, and links morphology to surgical decisions. Methods: Integrative narrative review (January 1900–October 2025) of PubMed/MEDLINE, Scopus, and Web of Science covering vascularization (pedicles, perforators), innervation (motor points/segments), imaging (ultrasound, MRI, MR neurography, CTA/MRA), and clinical applications (facial reanimation, elbow flexion, perineal and breast reconstruction). Two reviewers screened/extracted with consensus adjudication. Searches were restricted to English or records with reliable English-language summaries. Results: IGF consolidates morphological variants, motor-point/segmental innervation, and pedicle/perforator patterns with imaging correlates and common pitfalls. It provides a crosswalk mapping historical systems to IGF and a proposed preoperative workflow (anatomy → imaging → harvest → neurotization) for structured planning and reporting (proposed framework; not prospectively validated). We summarize considerations for free/functional gracilis in facial reanimation and elbow-flexion, and for pedicled/free myocutaneous or perforator flaps in perineal and breast reconstruction. Conclusions: IGF offers a standardized language and decision scaffold to improve study comparability and transparency in operative reporting; as a nonvalidated synthesis, it requires systematic validation through cadaver–imaging correlation and prospective surgical cohorts. Full article

Background/Objectives: Adult spinal deformity (ASD) correction is a complex surgery to restore spinal alignment and relieve patients’ symptoms. Modern techniques and technologies allow for aggressive surgical correction in tissue-friendly ways that preserve anatomy and may enable faster recovery. Robotic-assisted posterior spinal stabilization may be used as an adjunct to complex ASD reconstruction to facilitate a minimally invasive approach, reduce perioperative morbidity and physiological insult, and allow for the performance of procedures traditionally reserved for large academic centers to be effectively performed by qualified surgeons in optimized patients at smaller hospitals with fewer resources. The objective of this study is to assess realignment, perioperative complications, and patient-reported outcomes of complex, minimally invasive, robotic-assisted adult spinal deformity correction in a surgical specialty hospital. Methods: Demographic, surgical, and perioperative data were collected from the medical record. The Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for pain scores were collected preoperatively and at regular post-op visits. X-rays were captured preoperatively before hospital discharge and at follow-up visits. Results: Fifty consecutive deformity patients were corrected with a two-stage approach (anterior column reconstruction followed by posterior stabilization with robotic-assisted screw placement on the next day) at a 48-bed (eight operating rooms), surgeon-owned, subspecialty hospital. The average patient age was 70 years, and 64% were female. The average estimated blood loss (EBL) values for the first and second stages were 62 mL and 205 mL, respectively. The average operative time was 172 min during the first stage and 210 min for the second stage. Three interbody spacers (first stage) and 16 screws (second stage) were inserted on average in each procedure. The average length of stay (LOS) in the hospital was 5 days, and the average follow-up period was 10.6 months. No patients required a transfer to another facility with intensive care unit (ICU) capabilities, and none required a revision of hardware placement. There was an average reduction in the lumbar coronal scoliotic curve of 14.5° and an increase in lumbar lordosis of 14.8° at the latest follow-up (p < 0.01). The average mismatch between pelvic incidence and lumbar lordosis (PI-LL) preoperatively was 17.6°, which was reduced to 9.6° at the latest postoperative follow-up (p < 0.01). Mean ODI (%) and NRS scores were significantly improved by 33.8% (46.7 ± 13.3 to 30.9 ± 19.8; p < 0.01) and 55% (6.0 ± 2.2 to 2.7 ± 2.6; p < 0.01), respectively, at last follow-up. Conclusions: This study demonstrates the feasibility of performing complex, robotic-assisted ASD corrective surgery in a surgical specialty hospital, achieving significant correction of sagittal and coronal deformities, relieving patients’ symptoms, and offering efficiency and consistency to pedicle screw placement. This study demonstrates that a minimally invasive approach to complex deformity reconstruction reduces perioperative morbidity with decreased operative times, EBL, and LOS when compared to historic controls. This approach allows for the democratization of deformity care in that procedures typically reserved for large academic centers can be successfully accomplished at smaller institutions in optimized patients by qualified surgeons with appropriate perioperative support staff. Full article

Background: The aim of the present narrative review is to synthesize the available scientific evidence comparing periodontal endoscopy-assisted therapy with established surgical regenerative procedures for the treatment of intrabony periodontal defects. While regenerative surgery—including papilla-preserving techniques—remains the standard approach for achieving predictable clinical attachment gain, these procedures may potentially compromise papillary integrity and healing dynamics. Periodontal endoscopy enables enhanced visualization and debridement without surgical access. This review evaluates available studies and discusses whether endoscopy-assisted therapy can achieve outcomes comparable to surgical regeneration while reducing tissue trauma and preserving interdental anatomy. Methods: A comprehensive literature search was conducted using the electronic databases PubMed, Web of Science, The Cochrane Library, and Scopus, supplemented by manual searching. The search was performed up to 1 November 2025. Results: Two studies were included. Overall, there is a substantial lack of RCTs directly comparing periodontal endoscopy-assisted therapy with surgical regenerative procedures. However, EASD (Endoscopic- assisted subgingival debridement) was found not to be inferior to papilla-preservation surgery (PPFS) for treating residual pockets in intrabony defects. Both PPFS and EASD were effective, although PPFS showed more consistent microbial modulation. Conclusions: Periodontal endoscopy-assisted therapy may be considered a promising minimally invasive approach for selected intrabony defects, potentially reducing surgical morbidity and preserving interdental tissues. Although early data suggest that endoscopy-guided approaches may offer comparable clinical improvements with less invasiveness, the evidence base is too small to support definitive recommendations. Robust, well-designed randomized trials are needed to define its clinical indications and compare it directly with established regenerative procedures. Full article

Background/Objectives: Reconstruction of orbital floor fractures remains surgically challenging due to limited intraoperative visibility and complex anatomy. Inaccurate implant placement often leads to persistent complications and the need for a revision surgery. This study evaluated the clinical accuracy and re-operation rates of a preoperative 3D-printed model-assisted technique compared to the conventional intraoperative free-hand mesh bending method. Methods: A comparative ambispective study was conducted on 74 patients with isolated orbital floor fractures. The control group (n = 34, retrospective) underwent reconstruction using intraoperatively formed titanium meshes. In the study group (n = 40, prospective), patient-specific 3D-printed models, created by mirroring the healthy contralateral orbit, were used for preoperative mesh adaptation. Primary outcomes included the rate of revision surgery due to implant malposition, changes in orbital volume, and postoperative diplopia. Results: The 3D model group demonstrated a significantly lower rate of revision surgery compared to the control group. In the retrospective group, 5 patients (15%) required reoperation due to implant malposition, whereas no patients (0%) in the prospective 3D group required secondary intervention (p = 0.017). While both techniques effectively restored orbital volume, the 3D group showed greater volumetric precision with less variance. The mean volume difference in the affected orbit was 3078 ± 2204 mm³ in the control group, compared to 2390 ± 1893 mm³ in the study 3D group. At the 6-month follow-up, persistent diplopia was observed in 12% of the control group compared to only 3% in the study group. Conclusions: The use of in-house 3D-printed models for preoperative mesh forming significantly enhances surgical precision and eliminates the need for revision surgery due to implant malposition. This workflow offers a cost-effective, predictable, and accessible alternative to expensive patient-specific implants (PSIs) or intraoperative navigation systems, improving patient safety and long-term clinical outcomes. Full article

Background and Objectives: Cardiac Syndrome X (CSX), a clinical entity within the Ischaemia with Non-Obstructive Coronary Arteries (INOCA) spectrum, is increasingly recognised as an inflammatory and systemic vascular disorder. Remnant cholesterol (RC) and inflammation are emerging contributors to residual cardiovascular risk; however, their combined role in microvascular angina remains unclear. This study aimed to evaluate the association between the remnant cholesterol inflammation index (RCII), integrating RC and high-sensitivity C-reactive protein (hs-CRP), and the clinical presence of CSX. Methods: This single-centre, retrospective observational study included 392 individuals who underwent coronary angiography between January 2023 and January 2025. The study population comprised 197 patients diagnosed with CSX and 195 control subjects with normal coronary anatomy and no objective evidence of myocardial ischaemia. RC was calculated as total cholesterol minus the sum of LDL-C and HDL-C, and RCII was derived as RC × hs-CRP. Importantly, invasive microvascular testing (e.g., CFR or IMR) was not performed. Logistic regression analyses were performed to identify independent predictors of CSX, and receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance. Results: Patients with CSX exhibited significantly higher levels of hs-CRP, SII, and RCII compared with controls (all p < 0.001). In the multivariable logistic regression analysis, RCII demonstrated an independent association with CSX (odds ratio 1.095, 95% confidence interval 1.060–1.131; p < 0.001). ROC curve analysis showed that RCII provided moderate but significant discrimination for CSX (area under the curve [AUC] 0.765, 95% CI 0.695–0.795). Pairwise comparisons confirmed that RCII had a significantly higher AUC than RC, hs-CRP, or SII individually. Conclusions: Higher RCII levels appear to be significantly associated with the clinical diagnosis of CSX. By integrating atherogenic remnant cholesterol burden and systemic inflammation, RCII may serve as a valuable composite biomarker for identifying residual inflammatory lipid risk. Rather than acting as a definitive diagnostic tool, these findings warrant further validation in large-scale prospective cohort studies. Full article

Brassica rapa is widely cultivated in alpine and cold mountainous regions due to its strong cold tolerance. However, lodging severely limits its yield and quality. This study integrated agronomic traits, stem microstructure, and transcriptomic profiles to explore the mechanism of lodging resistance by comparing a resistant cultivar (Ganyou 3064, GY) and a susceptible cultivar (Tianyou 2022, TY) across four developmental stages (full flowering, final flowering, podding, and maturity). At the four growth stages, the stem breaking strength of GY was 1.71, 1.93, 1.88, and 1.88 times that of TY, respectively. Compared with TY, the gravity center height of GY was decreased by 25.04%, 16.6%, 11.18%, and 8.98% at these four stages, respectively. Similarly, the lodging index of GY was decreased by 65.94%, 55.08%, 56.06%, and 55.63% compared with TY, respectively. Biochemical and anatomical analyses revealed that compared with TY, the lignin content of GY increased by 1.93%, 2.7%, 3.05%, and 3.42% at the four stages, while the cellulose content increased by 92.75%, 45.32%, 44.4%, and 49.92%, respectively. Meanwhile, the epidermal thickness, cortical thickness, vascular bundle length, vascular bundle area, and vascular bundle density of GY were also significantly increased. Transcriptomic and KEGG pathway analyses revealed a predictive defense mechanism of GY. At the final flowering stage, GY showed pre-activation of hormone and MAPK signal transduction, as well as phenylpropanoid biosynthesis; it shifted to energy supply and sustained cell wall reinforcement at the podding stage. In addition, upregulated genes in phenylpropanoid biosynthesis (such as PAL3, CCoAOMT, and CAD9) indicated that enhanced stem lignification is a key molecular determinant of lodging resistance. In summary, GY enhances its lodging resistance through coordinated morphological and transcriptional regulation. This study is the first to integrate the lodging characteristics of Brassica rapa, offering valuable candidate genes and phenotypic markers for molecular breeding. Full article

Background and Objectives: The association between spinal and pelvic alignment significantly impacts sagittal balance in adults. This study, that is retrospective, aims to investigate sagittal alignment anatomy of the pelvis and spine in juvenile idiopathic scoliosis (JIS) and adolescent idiopathic scoliosis (AIS) patients. Materials and Methods: We evaluated nine sagittal parameters from lateral radiographs of 100 JIS and AIS patients, including thoracic kyphosis (TKA), lumbar lordosis (LLA), pelvic tilt (PTA), pelvic incidence (PIA), spinosacral (SSA), sacral slope (SSLA), C7 tilt angles (C7-TA), sagittal vertical axis length (SVAL), and odontoid process hip axis angle (OPHAA) using the ImageJ program. Participants were classified based on their coronal curve group. Analysis of variance compared parameters between curve groups, and Pearson coefficients assessed the relationship between all parameters (p < 0.05). Results: Female participants had an average age of 13.4, and male participants had an average age of 13.0. Female participants had an average scoliosis degree of 19.3, while male participants had 15.2. PIA, PTA, SSLA, and SSA values were significantly higher in women participants than in men participants (p < 0.05). Additionally, PIA, PTA, SSLA, SSA, and OPHAA values were significantly lower in participants with a lower scoliosis degree (p < 0.05). We observed a moderately positive association between LLA and TKA, PIA, SSA, and C7-TA. There was also a moderate positive association between spinopelvic alignment parameters and the degree of scoliosis in participants. Conclusions: Easily measured values such as PIA, PTA, SSLA, SSA, and OPHAA may be related to severity of vertebral column deformities in patients, making them valuable for monitoring scoliosis patients. Full article

Background: Contemporary coronary artery bypass grafting (CABG) is often performed in patients with diffuse atherosclerosis, severe calcification, prior percutaneous coronary intervention (PCI), and fragile myocardium, creating intraoperative scenarios that can compromise target selection, anastomotic quality, and completeness of revascularization. We synthesize operative strategies and outcomes across five predefined “complex CABG” scenarios. Methods: A focused literature review was performed targeting intraoperative CABG challenges in adult patients. Two reviewers independently screened titles/abstracts and selected studies describing operative details, technical considerations, or outcomes relevant to (1) intramyocardial/embedded coronaries, (2) severely calcified or diffuse disease requiring reconstruction, (3) small-caliber targets/flow-limited grafting, (4) iatrogenic right ventricular (RV) injury, and (5) failed PCI/stent-related surgical management. Disagreements were resolved through discussion and consensus. Results: Thirty core publications were synthesized across five complex intraoperative CABG scenarios (intramural/embedded coronaries n = 7; calcified/diffuse disease n = 7; small-caliber/flow-limited targets n = 7; iatrogenic RV injury n = 5; failed PCI/stent-related management n = 5). Intramural/embedded targets: reported intramyocardial LAD prevalence ranged from 2.2–13%, and studies emphasized structured localization strategies with a small but real risk of ventricular injury depending on technique. Severely calcified/diffuse disease: reconstructive approaches (endarterectomy, patch angioplasty, long-segment LAD reconstruction) were used to create graftable beds when standard anastomosis was not feasible, with series reporting acceptable early mortality and generally high early-to-midterm patency when paired with planned antithrombotic and imaging follow-up strategies. Small-caliber targets: vessel size alone did not preclude durable grafting when flow was optimized, with evidence supporting flow-augmenting designs (e.g., sequential grafting) and intraoperative flow verification to reduce low-flow failure in limited runoff beds. Iatrogenic RV injury: bailout techniques prioritized rapid hemostasis while preserving LAD/graft patency using buttressed closure concepts designed for constrained exposure and ongoing bleeding risk. Failed PCI/stent-related pathology: long stented segments shifted operative planning from distal target selection to target reconstruction (stentectomy/endarterectomy with long-segment LAD reconstruction), with angiographic follow-up cohorts demonstrating feasible revascularization but variable patency by territory and lesion extent. Conclusions: Complex CABG is best approached as structured, anatomy-driven problem-solving: deliberate target localization, creation of a graftable bed when needed, flow-augmenting graft design, and predefined bailout options. Standardized comparative studies are needed to define optimal strategies across these common clinically important scenarios. Full article

The adrenal glands are central regulators of endocrine function and stress physiology, yet detailed species-specific anatomical baselines remain limited in cetaceans. This study provides a comprehensive gross, histological, morphometric, and ultrastructural characterization of the adrenal glands in 55 short-beaked common dolphins (Delphinus delphis) examined postmortem in the Canary Islands. Adrenal glands were evaluated macroscopically and microscopically, and histological corticomedullary ratios were calculated from mid-transverse sections. Associations with body length, sexual maturity, and cause-of-death category were assessed statistically. Transmission electron microscopy was used to characterize cortical and medullary cellular ultrastructure. Adrenal weight showed a positive correlation with body length. The histological corticomedullary ratio showed no lateral asymmetry but differed significantly between sexually immature and mature individuals, indicating ontogenetic remodeling of adrenal architecture. In contrast, the corticomedullary ratio did not differ significantly between adult dolphins that died from acute events and those that died following more progressive pathological conditions. Ultrastructural analysis identified characteristic steroidogenic cortical cells and two distinct chromaffin cell populations in the medulla. These findings establish the first integrated anatomical baseline for the adrenal gland in Delphinus delphis, providing essential reference data for comparative anatomy, veterinary pathology, and the interpretation of endocrine-related findings in cetaceans. Full article

In the North China Plain (NCP), wind and rain during the grain-filling period of winter wheat can cause lodging. The second basal internode (I2), a key load-bearing structure, plays a central role in yield stability. This study, under a constant nitrogen (N) application rate of 270 kg ha⁻¹, aimed to clarify how nitrogen basal-to-topdressing ratios regulate I2 characteristics to balance lodging resistance and yield increase. Field experiments were conducted across two seasons with three cultivars and three nitrogen split ratios (5:5, CK; 3:7, N1; and 7:3, N2). Dynamic measurements of I2 mechanical properties, morphology, anatomy, and composition were taken, and structural equation modeling (SEM) was used for analysis. Results showed that the culm lodging resistance index (CLRI) decreased by 41.8% from flowering to milk stage under all treatments, with CLRI at the milk stage of lodging treatments between 0.11 and 0.15. SEM supported a composition–structure–lodging resistance–yield chain, with CLRI as the key mediator. The N1 treatment significantly improved CLRI at all stages and increased yield by 12.2% compared to CK, making it a recommended nitrogen strategy for improving both yield and lodging resistance. These findings provide agronomically applicable nitrogen management guidelines for high-yield winter wheat systems. Full article

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two dominant revascularisation strategies for obstructive coronary artery disease, yet their relative roles continue to shift because they address coronary pathophysiology differently with ever-evolving techniques. PCI has advanced through iterative improvements, including balloon angioplasty, bare-metal stents, and drug-eluting stents, with contemporary outcomes increasingly driven by procedural optimisation using intracoronary imaging and physiology-guided lesion selection rather than device category alone. CABG has progressed through perioperative management, improvements in operative safety, and, critically, conduit durability. Recognition of progressive saphenous vein graft failure has underpinned a conduit-optimisation era in which the left internal mammary artery to left anterior descending artery remains the gold standard. Further, broader arterial grafting (including radial artery use, multiple arterial grafting, and selected total-arterial strategies) has been increasingly applied, albeit with deliverability and competing-risk constraints highlighted in randomised evidence. This perspective review reframes the CABG versus PCI comparison not as a binary contest, but as a context-dependent assessment in which the relative value of each strategy depends on the specific technologies, techniques, and conduits available at the time of comparison. We summarise comparative effectiveness where evidence is most consistent and where it remains sensitive to anatomy, comorbidity, and endpoint definitions. In diabetes with multivessel disease, trial data favour CABG for long-term survival and clinical outcomes despite higher stroke risk. In left main disease, outcomes depend on lesion pattern and overall complexity, with trial-era stent technology and composite endpoint definitions influencing conclusions. In ischaemic left ventricular dysfunction, a long-term survival benefit is established for CABG added to medical therapy, while multi-vessel PCI has not demonstrated comparable prognostic modification in contemporary data. We then examine hybrid coronary revascularisation as territory-specific allocation, highlighting its physiological rationale, program dependence, and limited, adequately powered randomised evidence. Finally, we outline how artificial intelligence (AI) and robotics may accelerate a precision revascularisation paradigm by standardising lesion assessment, supporting procedural planning, improving procedural reproducibility, and enabling more patient-specific selection among PCI, contemporary CABG with optimised conduits, and hybrid pathways. Full article