Endarteriectomy of the left coronary artery (LCA) as a supplementary surgical means of myocardial revascularization with aortocoronary vein bypass procedure.

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In order to establish a satisfactory vein bypass anastomosis during myocardial revascularization, 2 findings are of special importance: the local wall quality and the actual lumen of the coronary artery, both altered by the arteriosclerotic disease. In certain cases, with diffuse triple vessel disease, the intraoperative decision for an endarteriectomy as a supplementary surgical means appears to be a logical consequence. In our own patient group of 50 restudied patients with an endarteriectomy of the LCA, we had a patency rate of 72%; in a subgroup it was as high as 84%, if performed locally and under full vision. Compared with extended core extraction, the latter technique only showed minor vessel irregularities proximal and distal to the bypass anastomosis and thus, in a long-term view, it opens up additional revascularization possibilities for severe coronary artery sclerosis.