Coronary endarterectomy to facilitate bypass surgery for patients with extensive stenting of the left anterior descending artery

Filippone, Gianfranco; Calia, Claudia; Vacirca, Sara Rita; Caruana, Giovanni; Re, Maria R.; Giardina, Caterina; Lentini, Emanuele; Villalba, Cesira Palmeri Di; Argano, Vincenzo

doi:10.1097/mca.0000000000000575

Cited by 3 publications

(4 citation statements)

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“…The incidence of coronary in-stent restenosis ranges from 14% to 60% [Kappetein 2013;Fukui 2005]. Few studies reported on the efficacy and safety of endarterectomy with concomitant CABG, suggesting that it is the best procedure in such patients, particularly in cases of "full metal jacket" or in diffusely diseased vessels [Fukui 2005;Demirsoy 2006;Filippone 2018;Zattera 2010].…”

Section: Discussionmentioning

confidence: 99%

“…Twenty-one patients were included in the present study, thereby the present study presents one of the largest series of patients with totally occluded LAD stent full metal jacket undergoing this procedure, as most previous studies consisted of either a case report of a single patient or a series of three to 12 patients [Fukui 2005;Demirsoy 2006;Filippone 2018;Zattera 2010;Shapira 1999;Srimurugan 2018].…”

Section: Discussionmentioning

confidence: 99%

“…No deaths were recorded in their series after a median follow-up period of 24 months. Filippone et al [Filippone 2018] reported on two men who underwent stent endarterectomy on LAD and CABG. They stated that the postoperative period was uneventful, and patency of the LAD bypass graft was shown on coronary computed tomography angiography 6 months postoperative.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…LAD is the most important revascularisation site in coronary surgery and incomplete revascularisation of this vessel has been proven to be a predictor of short-and long-term mortality in the postoperative period (1). The widespread use of percutaneous interventions in recent years, the expansion of indications for stent implantations and use of repeated percutaneous transluminal coronary angioplasty in restenoses, together with the implantation of multiple stents into diffuse diseased vessels and distal stenoses have led to FMJ-LAD or LAD vessels featuring multiple intrastent restenosis.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Multiple Instent Restenosis With Coronary Endarterectomy and Stentectomy

Musayev

Kazimzade

Ahmadov

2021

AZJCVS

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In-stent restenosis remain the most important problem of coronary stent implantation. The number of patients with in-stent restenosis of coronary arteries is increasing in the practice of heart surgeons. We report a successful treatment of a patient with multiple in-stent restenosis of coronary arteries. LAD was treated with long arteriotomy of about 8 sm followed by open coronary endarteriectomy and stentectomy. The arteriotomy was then reconstructed with a venous patch and distal anastomosis with the LIMA then performed. The patient’s postoperative period was uncomplicated. At a 6-month followup examination, the patient is doing well and is asymptomatic. Combined open endarterectomy and stentectomy appears to be an effective alternative surgical treatment of FMJ-LAD and multiple intra-stent restenoses and gives a chance of full revascularization for such patients. Key words: Surgical management, coronary endarterectomy, stentectomy, arteriotomy, patient, FMJ-LAD

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