Salvage extensive coronary thromboendarterectomy for a ruptured left anterior descending artery

Area of Science:

• Cardiology
• Vascular Surgery

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
• The left anterior descending (LAD) artery is a critical vessel often targeted in CABG.
• Diffuse disease and calcifications can pose challenges during bypass surgery.

Observation:

• A 63-year-old male experienced syncope during exercise four days post-CABG.
• Emergency catheterization showed patent bypass grafts but no flow in the LAD artery.
• Percutaneous coronary intervention (PCI) led to LAD perforation and cardiogenic shock.

Findings:

• Emergent thromboendarterectomy of the entire LAD artery was successfully performed.
• The procedure restored flow and reversed cardiogenic shock.
• This intervention proved lifesaving in a complex post-CABG scenario.

Implications:

• Thromboendarterectomy can be a viable rescue strategy for critical LAD occlusion post-CABG.
• It offers an alternative when PCI is complicated or unsuccessful.
• This case highlights the importance of advanced surgical techniques in managing complex cardiac emergencies.