Coronary Endarterectomy and Stent Removal in Patients With In-Stent restenosis

Background In-stent restenosis (ISR) remains the major limitation of coronary stent implantation. Controversies exist regarding optional treatment for ISR. Recently, we developed aggressive surgical options, coronary endarterectomy and stent removal, in this complex setting. Methods Between April 2001 and March 2004, 11 consecutive patients who presented with angina and angiographically severe ISR were treated with coronary endarterectomy and stent removal with concomitant multivessel coronary bypass grafting. There were 10 men and 1 woman. The age ranged from 43 to 75 years old (mean 64.1 ± 9.6 years). The mean number of target vessel interventions was 1.6 ± 0.7. Data were analyzed retrospectively. Results The target vessel was the left anterior descending artery (LAD) in all patients. The mean interval from the last intervention was 4.8 ± 1.9 months. The mean number of target vessel interventions was 1.6 ± 0.7. The mean LAD incision length was 57.3 ± 11.0 mm. The left internal mammary artery (LIMA) was grafted in situ, as an on-lay patch. Procedural success without in-hospital complications was achieved in all cases, except one patient with low output syndrome. Postprocedure angiography demonstrated that all LIMA patches and LAD arteries were patent and left ventricular functions were preserved. Conclusions Coronary endarterectomy and stent removal with on-lay LIMA patch is a safe and effective technique used in patients with ISR involving diffuse target vessel disease.