Acute thrombosis after endarterectomy of stented left anterior descending artery

Uchimuro, Tomoya; Fukui, Toshihiro; Mihara, Wahei; Takanashi, Shuichiro

doi:10.1510/icvts.2008.201194

Cited by 15 publications

(11 citation statements)

References 7 publications

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“…Our practice is to maintain dual antiplatelet therapy for at least three months following endarterectomy. In addition, the use of heparin and/or warfarin in the postoperative period has been described to avoid acute thrombosis 16,17 . We do not routinely employ anticoagulation for these patients.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Coronary Artery Endarterectomy on Outcomes During Coronary Artery Bypass Grafting

LaPar

Anvari

Irvine

et al. 2011

Journal of Cardiac Surgery

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Background The impact of coronary artery endarterectomy during coronary artery bypass grafting (CABG) has been debated. We examined the early and late outcomes of CABG with endarterectomy (CE) compared to CABG alone. Methods Patients undergoing isolated CABG operations from 2003 to 2008 were retrospectively reviewed. We identified 99 patients who underwent CE and 3:1 propensity matched them to 297 CABG-alone patients based upon clinical factors: Society of Thoracic Surgeons (STS) predicted risk of mortality, age, gender, year of surgery, and ejection fraction. Patient risk factors as well as short-and long-term outcomes were compared by univariate and Kaplan-Meier analysis. Results Preoperative risk factors were similar between patients undergoing CE or CABG alone. Cross-clamp times (95.6 vs. 71.8 minutes, p = 0.0001) and perfusion times (121.8 vs. 92.7 minutes, p = 0.0001) were longer in patients undergoing CE. Operative mortality (4.0% vs. 1.3%, p = 0.112) and postoperative complications were not significantly different between groups. Patients undergoing coronary endarterectomy incurred longer ICU (75.06 vs. 48.64 hours, p = 0.001) and hospital stays (9.01 vs. 7.7 days, p = 0.034). Long-term mortality (mean follow-up = 27.7 ± 17.7 months) was equivalent despite revascularization technique (p = 0.13); however, patients undergoing CE encountered worse overall freedom from myocardial infarction (MI) (p = 0.03). Conclusion Patients undergoing CABG with coronary CE required longer ventilatory support and ICU stay yet have comparable operative mortality, major complication rates, and long-term survival to isolated CABG. Coronary endarterectomy should be considered an acceptable adjunct to CABG for patients with extensive coronary artery disease to achieve complete revascularization.

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Section: Discussionmentioning

confidence: 99%

The Impact of Coronary Artery Endarterectomy on Outcomes During Coronary Artery Bypass Grafting

LaPar

Anvari

Irvine

et al. 2011

Journal of Cardiac Surgery

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“…The most disastrous complication after CE is acute thrombotic occlusion of the reconstructed LAD [24]. The mechanism of thrombus formation in the endarterectomized vessel is that the absence of endothelium exposes the subendothelial tissue to the bloodstream, which can trigger the coagulation cascade.…”

Section: Commentmentioning

confidence: 99%

Ten-Year Experience of Coronary Endarterectomy for the Diffusely Diseased Left Anterior Descending Artery

Nishigawa

Fukui

Yamazaki

et al. 2017

The Annals of Thoracic Surgery

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“…The most feared major complication following coronary stent endarterectomy in cases of in-stent restenosis is the occurrence of acute thrombosis in the stent endarterectomized artery [Uchimuro 2009]. Thrombosis occurs in these cases because of the loss of endothelium, exposing the subendothelial tissue to the blood stream, and consequently the coagulation cascade is triggered.…”

Section: Discussionmentioning

confidence: 99%

Early and Midterm Results of Stent Endarterectomy for Left Anterior Descending Coronary Artery “Full Metal Jacket”

Soliman

Ohri

Hagag

et al. 2021

HSF

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Objective: Modern coronary interventional practice can result in coronary vessels that are totally stented. The term “full metal jacket” has been coined to refer to vessels that have an overlapping stent in series along the whole length of the vessel. This poses a serious challenge to surgical revascularization, particularly when a left internal thoracic artery (LITA) to the left anterior descending (LAD) needs to be undertaken. We evaluated the early and midterm results of on-pump coronary artery bypass grafting (CABG) following “stent endarterectomy” for the LAD with LITA to LAD grafting. Methods: During October 2017 to September 2020, 21 patients presented with multi-vessel disease and a totally occluded LAD with a stent full metal jacket. No distal target for LITA grafting was available, despite a viable myocardial territory. The LAD was endarterectomised, removing the column of totally occluded stents with the medial wall of the vessel, leaving the proximal stent in place to avoid competitive flow. Long length anastomosis was then undertaken with the LITA graft. Postoperatively, patients were followed up clinically and by coronary computed tomography (CT) angiography at 6- and 18-month intervals. All patients were discharged on a combination of aspirin and warfarin for three months and then aspirin and clopidogrel for the rest of the first year and then aspirin alone for life. Results: Patients had a mean age of 58.07 ± 2.06 yr. Sixteen (76.2%) were males, 13 (61.9%) patients were diabetics, 18 (85.7%) were hypertensive, 15 (71.4%) were dyslipidemic, six (28.6%) were obese, 11 (52.4%) were smokers, and five (23.8%) had positive family history of ischemic heart disease (IHD). The number of grafts per patient ranged 3-5, with a mean cross-clamp time of 64.71± 8.84 min. There were no postoperative deaths nor MI clinically, by electrocardiogram (ECG) criteria nor by troponin or CK-MB. In-hospital complications included one (4.8%) patient who required re-exploration for bleeding, one (4.8%) developed a superficial wound, and three (14.3%) developed atrial fibrillation (AF), during their hospital stay. Mean hospital stay was 7.71±1.73 days. All patients completed the 6-month follow up showing patent LITA to LAD with coronary CT angiography. One patient was lost to follow up after six months; five patients are awaiting their 18-month CT angiography, while 15 (71.4%) patients have completed their 18-month CT angiography, and all have a patent LITA to LAD. Conclusions: Stent endarterectomy for a totally occluded LAD with a full metal jacket and viable myocardial territory is a safe procedure with good early and midterm results. This technique should be considered in these difficult cases presenting for revascularisation when no other option is available.

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Acute thrombosis after endarterectomy of stented left anterior descending artery

Cited by 15 publications

References 7 publications

The Impact of Coronary Artery Endarterectomy on Outcomes During Coronary Artery Bypass Grafting

The Impact of Coronary Artery Endarterectomy on Outcomes During Coronary Artery Bypass Grafting

Ten-Year Experience of Coronary Endarterectomy for the Diffusely Diseased Left Anterior Descending Artery

Early and Midterm Results of Stent Endarterectomy for Left Anterior Descending Coronary Artery “Full Metal Jacket”

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