Original articleCardiovascularCoronary Endarterectomy and Stent Removal in Patients With In-Stent restenosis
Section snippets
Patient Population
Between April 2001 and March 2004, we performed coronary artery bypass surgery on 762 patients. Ninety-eight patients (12.9%) were treated previously with coronary stent implantation by interventional cardiologists. Eleven patients underwent coronary endarterectomy and stent removal before bypass grafting. Patient characteristics are listed in Table 1. The age range was from 43 to 75 years old (mean 64.1 ± 9.6 years). The mean Canadian Cardiovascular Society (CCS) functional class was 2.4 ±
Procedural Data
Of 98 patients who presented with ISR and underwent coronary bypass grafting, 11 whose LAD was diffusely diseased with an involvement of stent underwent stent removal and LAD endarterectomy. Other 87 patients were treated with simple bypass grafting to LAD or sequential bypass grafting to LAD and a diagonal branch because their side branches were not involved with lesions of ISR or their distal targets were suitable for anastomosis. Intraoperative data are listed in Table 2. The stent removal
Comment
Coronary in-stent restenosis remains a significant clinical problem, especially in the setting of diffuse disease [22]. Repeat percutaneous transluminal coronary angioplasty (PTCA) remains the most commonly used technique for ISR, but the rate of recurrence is very high, particularly in patients with diffuse ISR. Besides PTCA, ISR was treated by various other interventional techniques. However, long-term efficacy is unsatisfactory. Revascularization in diffusely diseased vessels may require
References (27)
- et al.
Mechanisms and results of balloon angioplasty for the treatment of in-stent restenosis
Am J Cardiol
(1996) - et al.
Directional atherectomy for treatment of restenosis within coronary stents: clinical, angiographic and histologic results
J Am Coll Cardiol
(1992) - et al.
Directional coronary atherectomy for the treatment of Palmaz-Schatz in-stent restenosis
Am J Cardiol
(1998) - et al.
Rotational atherectomy for in-stent restenosis: acute and long-term results of the first 100 cases
J Am Coll Cardiol
(1998) - et al.
Stenting the stent: initial results and long-term clinical and angiographic outcome of coronary stenting for patients with in-stent restenosis
Am J Cardiol
(2000) - et al.
Clinical trials of vascular brachytherapy for in-stent restenosis: update
Cardiovasc Radiat Med
(2001) - et al.
Sirolimus-eluting stent for treatment of complex in-stent restenosis: the first clinical experience
J Am Coll Cardiol
(2003) - et al.
Percutaneous and surgical interventions for in-stent restenosis: long-term outcomes and effect of diabetes mellitus
J Am Coll Cardiol
(2001) - et al.
Early and late results of coronary endarterectomyAnalysis of 3,369 patients
J Thorac Cardiovasc Surg
(1986) - et al.
Improved clinical outcomes in patients undergoing coronary artery bypass grafting with coronary endarterectomy
Ann Thorac Surg
(1999)
Bypass grafting with coronary endarterectomy: immediate and long-term results
J Thorac Cardiovasc Surg
Intracoronary stenting after unsuccessful PTCAEarly restenosis and explanation of stents during bypass surgery
Int J Cardiol
Successful surgical endarterectomy of a stented coronary artery
Ann Thorac Surg
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