DISCUSSION
This coronary endarterectomy procedure is a challenging procedure (7, 8)
because it increases the perioperative mortality, especially in LAD. For
this reason, most surgeons perform endarterectomy if there are no other
options for LAD (5).
Acceptable results of the coronary endarterectomy procedure have been
reported in recent literature (6).
Despite the the advers effects of coronary endarterectomy this procedure
must be kept in mind in the occluted arteries. There are two techiques
in coronary endarterectomy. In closed technique, shorter arteriotomy is
performed and the plaque is removed with traction. When performing
endarterectomy with a closed technique, the plaque may break and the
diagonal and septal branches branching from the LAD may not open, and
there is also a risk of disruption in the proximal and distal of the
LAD.
Open technique requires long incision extending into the proximal and
distal part of the artery. This technique allows to lift off the plaque
under vision. The incidence of intimal flap formation is low. The risk
of residuel obstruction, dissection, distal myocardial ischemia is low.
The open technique allows the entire atherosclerotic plaque to be
removed in full block. Open coronary endarterectomy technique: It should
include the branch and the branch of the LAD, it involves all your
removal including the most proximal and distal of the lesion in the LAD.
This technique is not only a time consuming procedure but also carries
the risk of proximal obstruction due to the unnoticed flash and the
catastrophic result.
This patient tolerated this technique and no problem. Although we found
this technique useful, it can not be put into daily practice especially
in LAD endarterectomy.