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Surgical Revascularization of the Left Anterior Descending Artery with Multiple Failed Overlapping Stents
Tolga Demir1, Mehmet Umit Egrenoglu1, Nursen Tanrikulu2
1Department of Cardiovascular Surgery, Kolan International Hospital, Istanbul, Turkey.
Insights
Coronary artery bypass grafting (CABG) using open stent endarterectomy offers a viable solution for complex left anterior descending artery blockages. This technique successfully treats patients with multiple failed stents, improving graft patency.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Standard coronary artery bypass grafting (CABG) techniques are challenging in patients with multiple overlapping stents in the left anterior descending artery (LAD).
- Failed stents in the LAD present a significant surgical hurdle.
Purpose of the Study:
- To describe a surgical approach for CABG in patients with multiple failed overlapping stents in the LAD.
- To evaluate the efficacy of open stent endarterectomy for LAD revascularization.
Main Methods:
- Retrospective review of six patients undergoing CABG with multiple failed overlapping stents in the LAD.
- Elective surgery involving open endarterectomy for stent removal and LAD reconstruction with a saphenous vein patch.
- Anastomosis of the left internal mammary artery to the saphenous vein patch.
Main Results:
- All six patients tolerated the procedure, with a mean hospital stay of 6.5 days.
- Postoperative angiography confirmed patency of all grafts, including the endarterectomized LAD.
- No 30-day mortality was observed, with a mean follow-up of 35.6 months.
Conclusions:
- CABG with open stent endarterectomy is a valuable alternative for treating "full-metal jacket" diseased LAD not amenable to standard surgical techniques.
- This approach provides successful revascularization in complex coronary artery disease cases.
Background:
Multiple stents make standard coronary artery bypass techniques difficult. We describe our surgical approach, in patients undergoing coronary artery bypass grafting (CABG), in left anterior descending arteries (LAD) with multiple failed overlapping stents.
Methods:
We retrospectively reviewed the data of six patients undergoing CABG with multiple failed overlapping stents in the LAD. All patients were operated on electively. After removal of the stents with an open endarterectomy, the long segmental arteriotomy of the LAD was reconstructed with a saphenous vein patch. Afterwards the left internal mammary artery was anastomosed to the vein patch.
Results:
The mean age was 61.5 ± 7.9 years. Five patients (83.3%) were in Canadian Cardiovascular Society Class III or IV. Four patients (66.6%) had suffered a remote myocardial infarction (>1 month). The average hospital stay was 6.5 ± 1.1 days. Postoperative electrocardiograms showed no specific changes and no myocardial enzyme elevations were noted. Early postoperative angiography showed that all grafts including the endarterectomized LAD were patent. There was no mortality within the 30 days. Patients' mean follow-up time was 35.6 ± 36.7 months.
Conclusions:
CABG with open stent endarterectomy is a valuable alternative option for patients with "full-metal jacket" diseased LAD that are not graftable using standard surgical techniques.
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