Surgical removal of stent from multiply stented vessel: problem with choice of place for anasthomosis — one year follow-up

Abstract

Since the advent of percutaneous coronary intervention there have been increasing numbers of patients with so-called ‘full metaljacket’ coronary arteries disease. This is creating a challenging problem for the cardiac surgeon. A 73 year-old woman after theimplantation of two metal stents to the left anterior descending artery (LAD) and four to the right coronary artery (RCA), withejection fraction of 28%, significant mitral and tricuspid insufficiency, and high systolic pulmonary pressure, was admitted toour department with unstable angina and with symptoms of pulmonary oedema. Coronary angiogram revealed restenosis in allstents. She agreed to a coronary artery bypass graft (CABG) with mitral and tricuspid valve reconstruction. The RCA was openedjust above the postero-lateral branch. Due to lack of space, the metal stent was removed and saphenous bypass graft performed.Six months later, control angiography showed a properly working LITA–LAD graft; the stents in the RCA had been occluded aboveanasthomosis and the venous graft to RCA had been stenosed. Percutaneous cardiac intervention was performed and the metal stentwas implanted with good early effect. After a further six months, coronarography revealed in stent stenosis in the place of venousanasthomosis. The patient was qualified for conservative treatment. Long term results after such procedures are hard to predict;we believe patients should be qualified earlier for CABG and that doctors should avoid implanting too many stents into one artery.