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.