Surgical approaches in left anterior descending artery in-stent stenosis
Bayram Yilmazkaya1, Renda Circi, Umit Pinar Circi
1Department of Cardiovascular Surgery, Akay Hospital, Ankara, Turkey.
Insights
In-stent stenosis, a complication of coronary interventions, can necessitate aggressive surgery. Stent removal with coronary endarterectomy is an effective and safe treatment for long-segment in-stent stenosis.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- In-stent stenosis is a significant complication of coronary interventions, particularly with extensive use of intracardiac devices in long coronary segments.
- This complication often requires aggressive surgical management.
Purpose of the Study:
- To evaluate the efficacy and safety of stent removal with coronary endarterectomy for long-segment in-stent stenosis.
- To assess surgical approaches for managing complex in-stent stenosis cases.
Main Methods:
- Seven patients with long-segment left anterior descending artery in-stent stenosis underwent surgical intervention between June 2006 and October 2007.
- Two minimally invasive off-pump procedures and five procedures using cardiopulmonary bypass were performed.
- All patients received coronary stents 3-11 months prior to surgery.
Main Results:
- The study included 7 male patients aged 43-71 years.
- Mean follow-up was 6.33 months, with all patients undergoing postoperative coronary angiography.
- The study focused on managing in-stent stenosis in the left anterior descending artery.
Conclusions:
- Long-segment in-stent stenosis complicates subsequent coronary artery bypass grafting.
- Stent removal combined with coronary endarterectomy is presented as the preferred technique.
- This approach is deemed effective and safe for treating complex in-stent stenosis.
Background:
In-stent stenosis remains the major disadvantage of coronary interventions. Extensive applications of the intracardiac devices especially involving long segments of coronary arteries have resulted in an increase in the number of cases of in-stent stenosis. That may require aggressive surgical approaches.
Methods:
Between June 2006 and October 2007, 7 patients with long-segment left anterior descending artery in-stent stenosis were operated on in our institution. Two of the operations were off pump with minimally invasive techniques, whereas the latter 5 patients were operated on through cardiopulmonary bypass.
Results:
All patients were male, except for the last patient; their ages were between 43 and 71 years (59.67 +/- 12.36). They all had received an intracoronary stent for the left anterior descending artery (3 to 11 months before surgery). The first 2 operations were minimally invasive off-pump procedures; however, the latter 5 were with cardiopulmonary bypass. Mean follow-up was 6.33 +/- 4.13 months, and a postoperative coronary angiogram was performed on all the patients.
Conclusions:
Although long-segment in-stent stenosis complicates subsequent coronary artery bypass grafting operations, stent removal with coronary endarterectomy seems to be the technique of choice because it is effective and safe.
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