Multi-vessel endarterectomies to revascularize eight coronary artery branches

Coronary endarterectomy (CE) is an adjunct procedure along with coronary artery bypass grafting (CABG) to ensure complete revascularization in diffuse coronary artery disease (CAD). In spite of its benefits, the procedure has not been adopted widely due to technical complexities and poor outcomes associated with incomplete endarterectomies. In view of the progressive increase in coronary interventions for triple-vessel disease, patients referred for CABG have diffuse disease in all coronaries, necessitating multiple endarterectomies to ensure complete revascularization. Multiple CE is an uncommon occurrence due to apprehensions of complex coronary reconstruction and postoperative graft thrombosis with poor outcomes. This unique case not only demonstrates a safe technique but also the feasibility of multiple CE up to four-vessel endarterectomy with revascularization of eight coronary artery branches (left anterior descending (LAD); diagonal, obtuse marginal (OM)-1 and its branch, OM-2; right coronary artery (RCA); posterior descending (PDA); posterolateral branch (PLB)) in a patient with severe, diffuse CAD.