Surgical Intervention for Diffuse Calcified Coronary Arteries: A Dual Heart-Brain Protection Strategy via Minimally Invasive Patch Reconstruction 💡

Surgical Intervention for Diffuse Calcified Coronary Arteries: A Dual Heart-Brain Protection Strategy via Minimally Invasive Patch Reconstruction 💡

Surgical intervention carries high risks for diabetic patients presenting with diffuse calcific occlusion of the entire LAD, complicated by severe multi-vessel intracranial artery stenosis.

Recently, Dr. Dongsheng Xia’s team at Fuwai Hospital managed such a complex case. Here is a review of the clinical decision-making process, exploring the synergistic application of minimally invasive techniques and vascular reconstruction.

📝 Case Profile & Clinical Challenges The patient is a 62-year-old female with a long-standing history of type 2 diabetes. ⚠️ Lesion characteristics: Diffuse calcific occlusion of the mid-to-distal LAD (extremely narrow lumen); meanwhile, cranial angiography indicated prior cerebral infarction and severe stenosis of multiple cerebral arteries.

🤔 Intervention Strategy Assessment ❌ PCI: Severe vascular calcification prevented device passage and dilation. ❌ Conventional CABG: Median sternotomy involves significant trauma, and intraoperative hemodynamic fluctuations could easily trigger a cerebral infarction. Furthermore, bypassing directly onto a severely calcified vessel limits long-term patency.

💡 Technical Approach: MIDCAB + Coronary Patch Reconstruction To ensure both hemodynamic stability and myocardial revascularization, the team adopted the following technical protocol:

1️⃣ 5-7cm Minimally Invasive Incision: Controlling Cerebrovascular Risk 🛡️ Procedure: Avoiding median sternotomy in favor of a 5-7 cm thoracic incision. 🎯 Objective: To minimize surgical trauma and systemic inflammatory response, maintain intraoperative hemodynamic stability, and avert perioperative stroke risk.

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2️⃣ IMA Patch: Addressing Diffuse Stenosis 🔪 Procedure: Incising the calcified LAD, harvesting the autologous internal mammary artery (IMA) to create a patch, and suturing it to widen the stenotic vessel. 🎯 Objective: To directly enlarge the main coronary lumen, providing a reliable anastomotic foundation for the bypass graft.

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3️⃣ Dual Blood Supply Reconstruction: Improving Long-term Patency 🔗 Procedure: Completing the IMA bypass on the reconstructed native vessel. 🎯 Objective: To establish a stable myocardial blood supply pathway, reducing the rate of late graft occlusion caused by long-segment calcification.

✅ Clinical Outcomes: Postoperatively, the patient maintained stable cardiac and cerebral hemodynamics, experiencing no complications such as stroke or bleeding. Chest tightness was relieved, and the patient was discharged smoothly.

For diffuse coronary lesions complicated by severe cerebrovascular disease, the combination of a minimally invasive approach and patch reconstruction offers a viable clinical pathway that balances surgical safety with long-term revascularization.