Off-pump coronary endarterectomy with stent removal for in-stent restenosis in the left anterior descending artery.

Abstract

In-stent restenosis (ISR) remains a major complication of percutaneous coronary intervention, even in the current era of drug-eluting stents (DESs). We reviewed the clinical and angiographic outcomes of coronary endarterectomy with stent removal using an off-pump technique in patients with ISR in the left anterior descending artery (LAD). Twelve patients with long-segment ISR in the LAD underwent off-pump coronary artery bypass grafting with coronary endarterectomy and stent removal at our institution from November 2005 to August 2012. Their mean age was 65.0 ± 6.3 years, and 11 were male. DESs were used in 10 patients and bare-metal stents were used in the remaining 2 patients. The interval from the latest intervention ranged from 4 to 102 months (median, 12 months). None of the procedures were converted to on-pump surgery, and there were no operative deaths. The left internal thoracic artery (LITA) was used to reconstruct the endarterectomized LAD in all patients, and the mean length of the arteriotomy in the LAD was 5.3 ± 1.0 cm. The LITA and LAD were patent in all patients on both early postoperative and follow-up angiography. At the median 24-month follow-up (range, 12-78 months), there were no late deaths and all patients were at a Canadian Cardiovascular Society class of 0 or I. Coronary endarterectomy with stent removal can be safely performed using an off-pump technique and provides favourable clinical and angiographic outcomes in patients with long-segment ISR in the LAD.