ABSTRACT
Most coronary artery presentations in aircrew result from atherosclerosis. Atherosclerosis is a progressive process, starting as early as the second decade. Other rare coronary artery conditions include: Coronary artery spasm, Coronary artery dissection, and aberrant coronary anatomy. Enlargement of atherosclerotic plaques over time may obstruct coronary blood flow and impair ability to meet myocardial oxygen demand when increased. Failure to meet myocardial demand usually occurs when plaque occludes at least 70% of the arterial lumen, at which point symptoms may develop. Even mild hypobaric hypoxia may be enough to exacerbate this in aircrew. To regain flying privileges, aircrew must be completely revascularised. Aircrew may, therefore, require intervention on diseased vessels beyond those deemed to be clinically significant. With percutaneous coronary intervention, drug eluting stents and bare metal stents are both acceptable in aircrew. Balloon angioplasty alone is not acceptable due to the high rate of re-stenosis.
