[Coronary revascularization in diabetic patient: which approach to choose?]

Diabetes constitutes a major risk factor for coronary artery disease, with often diffuse, calcified, and complex lesions, making the revascularization strategy particularly challenging. We report two clinical cases illustrating contrasting approaches in diabetic patients presenting with multivessel coronary disease. The first case involves a complex coronary angioplasty in the setting of acute coronary syndrome, guided by intracoronary imaging, highlighting the value of this modality in ostial left main lesions. The second case describes surgical revascularization in a stable patient with extensive coronary artery disease and left ventricular dysfunction, demonstrating the superiority of coronary artery bypass grafting in this context. These observations illustrate the importance of a personalized and multidisciplinary approach, based on current guidelines and the patient's anatomical and clinical characteristics. The advent of modern revascularization techniques and the anticipated results of the ANDAMAN study could soon redefine the standards of care for these high-risk patients.