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Acute thrombosis after endarterectomy of stented left anterior descending artery

Tomoya Uchimuro1, Toshihiro Fukui, Wahei Mihara

  • 1Department of Cardiovascular Surgery, Chiba Central Medical Center, Wakaba-ku, Chiba, Japan. tuchimuro@ccmc.seikei-kai.or.jp

Interactive Cardiovascular and Thoracic Surgery
|March 14, 2009
PubMed

Insights

Coronary endarterectomy complications include acute thrombosis. This case highlights successful recanalization of a thrombosed left anterior descending artery using a pacemaker, balloon pump, and anticoagulation.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Coronary endarterectomy is a surgical procedure to remove atherosclerotic plaque from a coronary artery.
  • Acute thrombosis is a rare but serious complication following coronary endarterectomy.
  • In-stent restenosis after stenting can necessitate complex interventions.

Observation:

  • A 65-year-old male developed sick sinus syndrome and acute myocardial infarction three days post-coronary endarterectomy.
  • The patient had a history of percutaneous stent implantation followed by endarterectomy with stent removal.
  • Coronary angiography confirmed thrombosis at the reconstructed site of the left anterior descending artery.

Findings:

  • The patient presented with acute myocardial infarction and sick sinus syndrome after coronary endarterectomy.
  • Thrombosis was identified in the endarterectomized left anterior descending artery.
  • A combination of pacemaker implantation, intra-aortic balloon pumping, and aggressive anticoagulation led to successful recanalization.

Implications:

  • This case underscores the potential for acute thrombosis after coronary endarterectomy, even after prior stenting.
  • Aggressive medical and mechanical support can achieve recanalization in complex thrombotic coronary events.
  • Management strategies for post-endarterectomy thrombosis require prompt and multi-faceted intervention.

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