Which one is preferable for each patient is still a matter of debate, but it is clear that in the presence of complex lesions,  significant Left Main Disease and in diabetic patients, CABG seems to offer better results to patients than PCI. Strong indications for CABG also include symptomatic patients and in cases where LV function is impaired., CABG offers better results that PCI in left main disease and in multivessel CAD, because of the protection arterial conduits offer to the native arteries of the heart, by producing vasodilator factors and preventing advancement of atherotic plaques. The question which modality has been studied in various trials. Patients with unprotected LM Disease (runoff of LM is not protected by a patent graft since previous CABG operation) were studied in NOBLE and EXCEL trials. NOBLE, which was published in 2016 is a multi-European country that found that CABG outperforms PCI in the long run (5 years). EXCEL, also published in 2016, found that PCI has similar results to CABG at 3 years, but this similarity fades at 4th year and later (CABG is better to PCI).Diabetic patients were studied in the FREEDOM trial, first published in 2012 and a follow up. It demonstrated a significant advantage in this group of patients when treated with CABG (vs PCI). The superiority was evident in a 3.8 year follow up and, an even further followup at 7.5 years, of the same patients documented again the superiority of CABG, enphasazing the benefits in smokers and younger patients.
There are by five characteristic features:
colonisation of endothelial cells by acid-fast bacilli
endothelial proliferation and marked thickening of vessel walls to the point of obliteration
angiogenesis
vascular ectasia
thrombosis of the superficial and mid-dermal blood vesselsThe likely pathogenesis is endothelial cell injury due to colonization/invasion followed by proliferation, angiogensis, thrombosis and vessel ectasia. Treatment
Lucios phenomenon is treated by anti-leprosy therapy (dapsone, rifampin, and clofazimine), optimal wound care, and treatment for bacteremia including antibiotics. In severe cases exchange transfusion may be helpful. == References ==