A Case of Diffuse Three Vessel Coronary Artery Disease With Triple Coronary Endarterectomy in 68-Years Old Patient Undergoing Coronary Artery Bypass Grafting
West-German Hear and Vascular Center, Essen, Germany.
Patient Demographics—A 68 years old male presented with stable angina pectoris and dyspnea on exertion. Relevant History—Medical history revealed arterial hypertension and hyperlipidemia but neither smoking, diabetes nor positive family history for coronary disease. Cardiac CT demonstrated an Agatston score of 450 (AU) and subsequent coronary angiography showed severe diffuse three vessel coronary disease. CCS-class II and SYNTAX-Score of 44. Pre-Operative Plan—Coronary artery bypass grafting with coronary endarterectomy when coronary vessel is occluded/sub-occluded to achieve full myocardial revascularization. Operative Course—Live in a Box video*. Conclusion—Patients with diffuse coronary artery disease are high-risk candidates for surgical revascularization requiring adequate experience of the operating surgeon. Traction CEA is our preferred method in comparison to open endarterectomy. Flushing the coronary vessel with cardioplegia besides proximal/distal vessel massaging to get rid of residual debris after CEA is mandatory to avoid early failure. In case of inadequate disruption of the distal CEA cylinder, a second incision for CEA completion including sequential anastomosis is required. Dual antiplatelet therapy seems to be supportive to achieve long-term patency of the endarterectomized vessel. Thus, complete revascularization with satisfactory prognosis is possible.
* Live in a Box video would be uploaded separately.
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