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Intimal regeneration after coronary endarterectomy and onlay grafting in coronary artery bypass grafting

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Abstract

Objectives

Coronary onlay grafting, with or without endarterectomy, has been widely used for the treatment of diffuse lesions. Recent studies have demonstrated excellent long-term patency and favorable remodeling of onlay anastomosis; however, the underlying mechanisms remain unknown. Here, we describe the mechanism of intimal regeneration based on postmortem pathological evaluation of a patient who had undergone onlay grafting with coronary endarterectomy.

Methods

The onlay anastomosis was analyzed using a combination of immunohistological stainings, namely, H&E, vimentin, α-SMA, factor VIII, and Ki-67, to identify the source and mechanism of intimal regeneration after onlay grafting with endarterectomy.

Results

Our results suggest that the regenerated endothelium derives from the smooth muscle cells of the endarterectomized media of the coronary artery and that it circumferentially covers the internal lumen of the arterial graft.

Conclusions

Intimal regeneration, derived from the smooth muscle cells of the endarterectomized coronary artery that proliferate toward the graft lumen, may be a key mechanism that underlies the observed favorable remodeling after onlay grafting during coronary endarterectomy.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan

    Takayuki Okada, Naoki Minato, Shin-ya Kanemoto & Nobuya Zempo

  2. Department of Stem Cell Pathology, Kansai Medical University, Osaka, Japan

    Kazuho Saiga, Ken Namikawa, Shohei Kanno & Hiroo Ueno

Authors
  1. Takayuki Okada
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  2. Naoki Minato
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  3. Shin-ya Kanemoto
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  4. Nobuya Zempo
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  5. Kazuho Saiga
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  6. Ken Namikawa
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  7. Shohei Kanno
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  8. Hiroo Ueno
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Correspondence to Takayuki Okada.

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Okada, T., Minato, N., Kanemoto, Sy. et al. Intimal regeneration after coronary endarterectomy and onlay grafting in coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 67, 677–683 (2019). https://doi.org/10.1007/s11748-019-01083-w

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  • DOI: https://doi.org/10.1007/s11748-019-01083-w

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