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Usefulness of thromboendarterectomy in association with coronary artery bypass grafting

M P Larock1, W Burguet, T Grenade

  • 1University of Liege, Institute of Medicine, Belgium.

The American Journal of Cardiology
|November 1, 1987
PubMed

Insights

Thromboendarterectomy combined with coronary artery bypass graft surgery (CABG) can be effective for severe blockages. However, it carries a higher risk of new myocardial infarction (MI) compared to standard grafts, especially in patients without prior MI.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Thromboendarterectomy is sometimes performed alongside coronary artery bypass graft surgery (CABG).
  • This procedure is typically used for right coronary arteries and severely narrowed vessels.
  • Perioperative acute myocardial infarction (AMI) is a potential complication.

Purpose of the Study:

  • To compare the outcomes of patients who underwent thromboendarterectomy with those who did not, in conjunction with CABG.
  • To evaluate the impact of previous AMI and lesion severity on the success of thromboendarterectomy.
  • To assess graft patency and the occurrence of new AMI or residual ischemia.

Main Methods:

  • A retrospective study of 176 patients undergoing CABG, with pre- and post-operative thallium-201 scintigraphy and angiography.
  • A matched cohort of 48 patients with thromboendarterectomy and 48 without were selected for detailed analysis.
  • Analysis considered vessel lesion severity (complete/incomplete), graft patency, and native coronary artery patency.

Main Results:

  • New AMI or residual ischemia occurred in 32% of areas treated with thromboendarterectomy versus 5% for standard grafts (p < 0.001).
  • In patients with previous AMI, reperfusion was more frequent via the native vessel after thromboendarterectomy.
  • Graft patency was lower overall and similar between groups without previous AMI; however, patients with previous AMI and thromboendarterectomy showed different reperfusion patterns.

Conclusions:

  • Thromboendarterectomy can achieve good results (64-75%) in selected subgroups when CABG is not feasible, particularly in cases of incomplete occlusion after AMI.
  • The procedure should be avoided in mildly or moderately stenotic arteries supplying non-infarcted myocardium due to increased risk of perioperative AMI.
  • Careful patient selection is crucial for optimizing outcomes when considering thromboendarterectomy with CABG.

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