[Coronary endarterectomy: has the time come for randomized evaluation of clinical research?]

The authors review contemporary and hitherto not uniform views on the clinical impact of endarterectomy in the surgical treatment of diffuse coronary disease. Exact evaluation of this problem is still lacking. The authors suggest an original, prospective project for the objective evaluation of this therapeutic method by a randomized study called PROCESS. Initial experience indicates that revascularization procedures with endarterectomy are in the early postoperative stage associated with a higher mortality and morbidity than conventional surgery using only bypasses without endarterectomy of diffusely altered coronary arteries. Hypothetically it is possible that the long-term fate of patients with more complete revascularization, i.e. with reconstruction of diffusely altered arteries, will be more favourable than the prognosis of patients with partial reconstruction of the coronary circulation. The objective of the proposed project is to test this hypothesis. This will be, however, possible only after a longer time interval.