Surgical Revascularization of the Left Anterior Descending Artery with Multiple Failed Overlapping Stents.
BACKGROUND
Multiple stents make standard coronary artery bypass techniques difficult. We describe our surgical approach, in patients undergoing coronary artery bypass grafting (CABG), in left anterior descending arteries (LAD) with multiple failed overlapping stents.


METHODS
We retrospectively reviewed the data of six patients undergoing CABG with multiple failed overlapping stents in the LAD. All patients were operated on electively. After removal of the stents with an open endarterectomy, the long segmental arteriotomy of the LAD was reconstructed with a saphenous vein patch. Afterwards the left internal mammary artery was anastomosed to the vein patch.


RESULTS
The mean age was 61.5 ± 7.9 years. Five patients (83.3%) were in Canadian Cardiovascular Society Class III or IV. Four patients (66.6%) had suffered a remote myocardial infarction (>1 month). The average hospital stay was 6.5 ± 1.1 days. Postoperative electrocardiograms showed no specific changes and no myocardial enzyme elevations were noted. Early postoperative angiography showed that all grafts including the endarterectomized LAD were patent. There was no mortality within the 30 days. Patients' mean follow-up time was 35.6 ± 36.7 months.


CONCLUSIONS
CABG with open stent endarterectomy is a valuable alternative option for patients with "full-metal jacket" diseased LAD that are not graftable using standard surgical techniques.
Department of Cardiovascular Surgery, Kolan International Hospital, Istanbul, Turkey.
Tolga
T
Demir
Department of Cardiovascular Surgery, Kolan International Hospital, Istanbul, Turkey.
Mehmet Umit
MU
Egrenoglu
Department of Anesthesiology, Kolan International Hospital, Istanbul, Turkey.
Nursen
N
Tanrikulu
Department of Cardiology, Kolan International Hospital, Istanbul, Turkey.
Ahmet Yasar
AY
Cizgici
Department of Cardiology, Kolan International Hospital, Istanbul, Turkey.
Kemal Ilker
KI
Yildirim
Department of Cardiology, Kolan International Hospital, Istanbul, Turkey.
Ismet
I
Dindar
Department of Cardiovascular Surgery, Kolan International Hospital, Istanbul, Turkey.
Ergun
E
Demirsoy
D000368:Aged; D000787:Angina Pectoris / Q000601:surgery; D001026:Coronary Artery Bypass / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery*; D020878:Device Removal / Q000379:methods*; D017558:Elective Surgical Procedures; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome