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[Intravascular ultrasound imaging on the endarterectomized coronary arteries in two patients]
T Fukuchi1, K Murase, Y Ohkawa
1Department of Cardiovascular Surgery, National Sanatorium Toyohashi-Higashi Hospital, Aichi, Japan.
Insights
Intravascular ultrasound imaging revealed endarterectomized coronary arteries have two distinct layers. Strict anticoagulant therapy is crucial post-endarterectomy to prevent thrombus formation.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
Background:
- Endarterectomy is a surgical procedure to remove plaque from arteries.
- Coronary artery disease often necessitates interventions like endarterectomy and bypass grafting.
Observation:
- Intravascular ultrasound imaging (IVUS) was used to assess endarterectomized coronary arteries in two patients.
- Coronary arteriography (CAG) confirmed patency of bypass grafts and endarterectomized segments.
Findings:
- IVUS demonstrated a two-layered structure in endarterectomized coronary arteries.
- The outer layer appeared hyperechoic, while the inner layer was heterogeneously echoic.
- Histological examination identified the inner layer as media, thrombus, and intimal hyperplasia.
Implications:
- Findings highlight the importance of rigorous anticoagulant therapy following coronary endarterectomy.
- Understanding the layered structure visualized by IVUS can aid in post-operative management.
- This study contributes to the literature on imaging and histology of endarterectomized coronary arteries.
Abstract:
Intravascular ultrasound imaging on the endarterectomized coronary arteries in two patients are reported with a review of the literature. Case 1, a 62-year-old male and case 2, a 64-year-old male underwent endarterectomy of the right coronary artery (#3--#4PD, 4AV) combined with coronary arterial bypass grafting. Coronary arteriography (CAG) and intravascular ultrasound imaging (IVUS) were performed one month after operation. CAG revealed bypass grafts and endarterectomized coronary arteries to be patent together, and IVUS revealed endarterectomized coronary arteries had two layers, outer layer to be hyperechoic and inner layer to be heterogenously echoic in both cases. The histological examination of specimens suggests this heterogenously echoic area represents media, thrombus and irregularly proliferated intima. Therefore, anticoagulant therapy after endarterectomy should be strictly performed.