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Coronary endarterectomy: the long-term local effects
R W Byard1, W J Keon, V M Walley
1University of Ottawa Heart Institute, Ottawa Hospital, Canada.
Insights
Manual endarterectomy of coronary arteries shows variable long-term effects. While some arteries thrombosed, others remained patent with myofibrointimal proliferation and potential for recurrent atherosclerosis.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Pathology
Background:
- Manual endarterectomy is a surgical procedure to remove atherosclerotic plaque from arteries.
- Coronary artery disease often necessitates interventions like endarterectomy and bypass grafting.
- Long-term outcomes of coronary endarterectomy require further investigation.
Purpose of the Study:
- To describe the chronic effects of manual endarterectomy on coronary arteries.
- To assess the long-term patency and histological changes in endarterectomized coronary arteries.
- To evaluate the incidence of recurrent atherosclerosis after coronary endarterectomy.
Main Methods:
- Autopsy analysis of coronary arteries from nine male patients who underwent endarterectomy and bypass grafting.
- Assessment of arterial patency, presence of thrombosis, myofibrointimal proliferation, and recurrent atherosclerosis.
- Correlation of pathological findings with the time elapsed since the surgical procedure.
Main Results:
- Eight out of nine endarterectomized coronary arteries remained patent for up to eight years post-procedure.
- Patent arteries exhibited variable myofibrointimal proliferation, with some showing significant stenosis.
- Recurrent atherosclerosis was observed focally in two of the patent endarterectomized arteries.
- One artery thrombosed shortly after the endarterectomy procedure.
Conclusions:
- Manual endarterectomy can provide long-term patency for coronary arteries.
- Myofibrointimal proliferation and recurrent atherosclerosis are potential chronic complications.
- These findings highlight the variable nature of long-term outcomes following coronary endarterectomy.
Abstract:
The chronic effects of manual endarterectomy of coronary arteries are described. Nine male patients (age, 58-70 years) had undergone right coronary endarterectomy and bypass grafting 6-9 years prior to death and autopsy. One of the nine endarterectomized arteries had thrombosed soon after the procedure, while the other eight had maintained blood flow for up to eight years. These patent arteries had variable myofibrointimal proliferation ranging from mild to marked, the latter with significant stenosis. Recurrent atherosclerosis was present focally in two endarterectomized arteries. Death had occurred from causes unrelated to pathology in the endarterectomized vessels and provided a unique opportunity to assess the variable long-term effects of this form of arterial injury.