[Shunting of coronary arteries less than 1.5 mm in diameter. Analytical review]

Widespread implementation of coronary artery stenting into clinical practice has resulted in the fact that nowadays predominantly difficult cohorts of patients with multiple occlusions and diffuse lesions have been sent to coronary artery bypass grafting, with a constantly increasing number of patients refused operations due to 'small' coronary arteries (less than 1.5 mm in diameter). We analyzed Russian and foreign scientific publications investigating the problem of bypass grafting of coronary arteries measuring less than 1.5 mm in diameter. This review considers small-diameter coronary arteries as a risk factor for and predictor of the worst prognosis in patients concerned, studying causes of possible occlusion of shunts to such arteries, and showing peculiarities of diagnosis and surgical treatment in such patients. It was noted that anastomoses performed using microsurgical technique in the majority of cases ensured complete revascularization, yielding favorable early postoperative outcomes. Nevertheless, no detailed comparative analysis of remote results to solve the problem of advisability of reconstructions of arteries less than 1.5 mm in diameter have hitherto been conducted. Besides, there are no clear-cut indications for, contraindications to, nor guidelines on shunting of small-diameter arteries, with no optimal technique devised. Hence, the problem concerning efficacy of CABG surgery using microsurgical technique for multiple shunting in patients with coronary artery less than 1.5 mm in diameter is one of the most urgent problems in modern coronary surgery.