How coronary endarterectomy can be a valuable adjunct to CABG in carefully selected patients with diffuse coronary disease when standard revascularization strategies are limited.
Video Highlights
Extensive LAD endarterectomy was performed to remove long-segment plaque and establish an adequate target for reconstruction and bypass grafting
Key principles of patient selection include assessment of myocardial viability and avoidance of endarterectomy in infarcted territories, as well as important technical considerations such as preserving branch runoff and achieving a tapering distal endpoint
Postoperative imaging confirmed graft patency, and the patient maintained normal ventricular function
In this surgical case presentation, Houston Methodist cardiovascular surgeon Dr. Marvin Atkins Jr. describes the management of a 69-year-old patient with severe diffuse multivessel coronary artery disease that was not amenable to conventional coronary artery bypass grafting alone.
Although coronary endarterectomy is performed infrequently, this case demonstrates its continued relevance for achieving complete myocardial revascularization in patients with diffuse coronary artery disease. The presentation reinforces several practical considerations for cardiovascular surgeons, including the importance of myocardial viability testing, intraoperative flow assessment, retrograde cardioplegia and meticulous plaque extraction technique. These lessons may help guide surgical management when traditional bypass targets are inadequate.