title: Surgical approaches in left anterior descending artery in-stent stenosis.
abstract: BACKGROUND
  In-stent stenosis remains the major disadvantage of coronary interventions. Extensive applications of the intracardiac devices especially involving long segments of coronary arteries have resulted in an increase in the number of cases of in-stent stenosis. That may require aggressive surgical approaches.
  
  
  METHODS
  Between June 2006 and October 2007, 7 patients with long-segment left anterior descending artery in-stent stenosis were operated on in our institution. Two of the operations were off pump with minimally invasive techniques, whereas the latter 5 patients were operated on through cardiopulmonary bypass.
  
  
  RESULTS
  All patients were male, except for the last patient; their ages were between 43 and 71 years (59.67 +/- 12.36). They all had received an intracoronary stent for the left anterior descending artery (3 to 11 months before surgery). The first 2 operations were minimally invasive off-pump procedures; however, the latter 5 were with cardiopulmonary bypass. Mean follow-up was 6.33 +/- 4.13 months, and a postoperative coronary angiogram was performed on all the patients.
  
  
  CONCLUSIONS
  Although long-segment in-stent stenosis complicates subsequent coronary artery bypass grafting operations, stent removal with coronary endarterectomy seems to be the technique of choice because it is effective and safe.
authors.affiliation: Department of Cardiovascular Surgery, Akay Hospital, Ankara, Turkey.
authors.forename: Bayram
authors.initials: B
authors.lastname: Yilmazkaya
authors.forename: Renda
authors.initials: R
authors.lastname: Circi
authors.forename: Umit Pinar
authors.initials: UP
authors.lastname: Circi
authors.forename: Sami
authors.initials: S
authors.lastname: Gurkahraman
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Yukselen
authors.forename: Omer Zuhtu
authors.initials: OZ
authors.lastname: Yondem
authors.forename: Oguz
authors.initials: O
authors.lastname: Tasdemir
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012086:Reoperation; D015607:Stents