Stentectomy for LAD "full metal jacket" with in-stent restenosis: How to do it

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Medicine

Background:

• Severe in-stent restenosis (ISR) in long "full metal jacket" lesions of the left anterior descending (LAD) coronary artery poses a significant treatment challenge, especially without distal targets.
• Traditional revascularization methods may be unsuitable for these complex cases, leading to limited therapeutic options.

Purpose of the Study:

• To describe a novel surgical technique for revascularizing symptomatic severe ISR in "full metal jacket" LAD lesions.
• To detail the methodology of stent removal (stentectomy), endarterectomy, and reconstruction using the left internal mammary artery (LIMA).
• To outline the post-procedure follow-up protocol, including antiplatelet/anticoagulation and angiography.

Main Methods:

• Surgical stent removal (stentectomy) under cardiopulmonary bypass with cardioplegic arrest.
• Coronary endarterectomy to address the underlying atherosclerotic disease.
• Reconstruction of the LAD using a skeletonized left internal mammary artery (LIMA) onlay patch graft.
• Comprehensive follow-up including antiplatelet/anticoagulation therapy and serial angiography.

Main Results:

• Successful surgical revascularization was achieved in patients with complex "full metal jacket" ISR.
• The described technique allowed for treatment in cases previously deemed untreatable.
• The follow-up protocol guided patient management and assessed procedural outcomes.

Conclusions:

• Surgical stentectomy with LIMA onlay patch reconstruction is a feasible and potentially beneficial advanced coronary procedure for select patients with severe ISR.
• Careful patient selection, multidisciplinary collaboration, and surgical expertise are crucial for successful outcomes.
• This approach expands treatment options for a challenging patient population in interventional cardiology.