Purpose.

The choice of tactics for myocardial revascularization in patients with multivascular disease of the coronary arteries after multiple stenting.

Materials and methods. Patient S., 52 years old, with a three-vascular disease of the coronary arteries, who had a history of 9 percutaneous interventions with a total of 13 stents and relapsed angina, underwent coronary artery bypass surgery by vital signs. Multislice computed tomography was performed to examine the viability of shunts in the postoperative period.

Results. The operation of coronary bypass surgery was performed in conditions of cardiopulmonary bypass and medical cardioplegia using microsurgical technique. Revascularization of all coronary arteries was performed by using three autovenous coronary artery bypass grafts and one mammarocoronary graft shunt. A control study on the 7th day after the operation using computed tomography revealed the viability of all grafts.

Discussion. Since the introduction of percutaneous coronary interventions for the treatment of coronary artery disease, the number of stenting procedures has increased multiplied times. In addition, with the accumulation of experience, the complexity of these procedures is growing. However, surgical revascularization using microsurgery for multivascular disease is a priority method of choice. However, aggressive re-interventions using multiple stents are becoming more common. Therefore, the number of candidates for coronary artery bypass grafting who have undergone multiple stenting is constantly growing. The question of choosing a tactic for myocardial revascularization for patients who had relapse of angina after angioplasty still remains debatable.

Conclusion. When choosing the type of re-revascularization for patients with restenosis and / or thrombosis after angioplasty and stenting of the coronary arteries, especially after repeated interventions, a balanced decision must be made. Also patient have to be informed about all possible postoperative results..