Surgical Revascularization of the Left Anterior Descending Artery with Multiple Failed Overlapping Stents

Demir, Tolga; Egrenoglu, Mehmet Umit; Tanrikulu, Nursen; Çizgici, Ahmet Yaşar; Yildirim, Kemal Ilker; Dindar, İsmet; Demirsoy, Ergün

doi:10.1111/jocs.12657

Cited by 5 publications

(2 citation statements)

References 9 publications

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“…Demir et al [Demir 2015] described six patients with LAD stent endarterectomy and CABG. Their patients underwent an uneventful postoperative period and were asymptomatic during the follow-up period, which ranged from three to 104 months.…”

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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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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“…Our indications for stentectomy, endarterectomy and CABG with the left internal mammary artery (LIMA) for severe ISR of LAD FMJ are: Severe ISR of a long segment of the LAD (FMJ), with CTO or subtotal occlusion being ideal (due to the likely development of collaterals to the anterior wall/septum). Poor or no distal targets with diffuse disease. Percutaneous techniques have been exhausted or are felt not to be beneficial. Septal perforator or diagonal branch(es) that could be revascularized through a stentectomy/endarterectomy. Significant viability in the anterior wall and septum 2 Symptoms (typically angina) are not controlled by optimal medical therapy and limiting the quality of life. Otherwise low‐to‐moderate surgical risk due to comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Stentectomy for LAD “full metal jacket” with in‐stent restenosis: How to do it

Rosati¹,

Sharma

Robbins

et al. 2021

Journal of Cardiac Surgery

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We report our technique for the surgical revascularization of symptomatic severe instent restenosis of a "full metal jacket" (≥60 mm overlapping stents) of the left anterior descending coronary artery without suitable distal targets: on-pump cardioplegic-arrest stent removal (stentectomy) with endarterectomy and skeletonized left internal mammary artery onlay patch reconstruction. We also describe our follow-up protocol, including antiplatelet/anticoagulation and angiography. With proper patient selection, multidisciplinary collaboration, and surgical expertise, this advanced coronary procedure can be beneficial to a growing population of patients otherwise deemed to be untreatable.

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A systematic review of right atrial bypass grafting in the management of central venous occlusive disease in patients undergoing hemodialysis

et al. 2022

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Introduction: Central venous occlusive disease (CVOD) is a complication that can occur in patients with end-stage renal disease who are receiving hemodialysis. When CVOD develops, patients often require multiple re-interventions to maintain their dialysis access. CVOD can be treated by various strategies such as balloon angioplasty, stenting, lower limb or extra-anatomical grafts, hybrid grafts or surgical bypasses such as right atrial (RA). In this systematic review, we aim to evaluate the indications, technical aspects, and outcomes after RA bypass grafting for the treatment of CVOD in hemodialysis patients. Methods: A systematic and comprehensive literature search was conducted using various electronic databases. We included articles that reported described and reported outcomes of RA bypass grafting for the treatment of CVOD in hemodialysis patients. A narrative review of the indications and technical aspects of RA bypass grafting was performed. We also pooled and reported the primary patency, secondary patency, postoperative complications, and 30-day mortality of RA bypass grafting. Results: A total of 21 studies with 55 patients who underwent RA bypass grafting were included in our systematic review. Follow-up period ranged from 0.5 to 84 months. The mean pooled primary patency and secondary patency of RA bypass grafting were 8.1 ± 4.9 and 21.7 ± 20.1 months, respectively. The incidence of early postoperative complications such as surgical site infection, bleeding, and access thrombosis was 0%, 4%, and 4%, respectively. The overall 30-day mortality was 4%. Conclusions: This systematic review summarizes the patient characteristics, technical features and outcomes of RA bypass grafting in the treatment of hemodialysis-related CVOD. RA bypass grafting may be a viable last-resort option when less invasive or conventional treatment options have been exhausted.

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Surgical Revascularization of the Left Anterior Descending Artery with Multiple Failed Overlapping Stents

Abstract: 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.

Cited by 5 publications

References 9 publications

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

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

Stentectomy for LAD “full metal jacket” with in‐stent restenosis: How to do it

A systematic review of right atrial bypass grafting in the management of central venous occlusive disease in patients undergoing hemodialysis

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