Surgical approaches in left anterior descending artery in-stent stenosis.
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.
Yilmazkaya
Bayram
B
Department of Cardiovascular Surgery, Akay Hospital, Ankara, Turkey.
Circi
Renda
R
Circi
Umit Pinar
UP
Gurkahraman
Sami
S
Yukselen
Mehmet Ali
MA
Yondem
Omer Zuhtu
OZ
Tasdemir
Oguz
O
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