Background: Multivessel coronary artery disease (CAD) presents a significant challenge in surgical management, with graft choice playing a crucial role in long-term outcomes. Arterial grafts, particularly complete arterial revascularization, offer superior patency and survival benefits compared to venous grafts. This case highlights the successful use of complete arterial revascularization in a patient with acute ischemic heart disease and multivessel CAD.
Case Summary: A 55-year-old male with a two-year history of diabetes and hypertension presented to the emergency department with acute, stabbing chest pain radiating to the left shoulder and back, accompanied by sweating. His vital signs were stable on admission. Laboratory tests showed elevated troponin levels, indicating myocardial ischemia. Transthoracic echocardiography revealed hypokinesia of the anterior left ventricular wall and mild mitral regurgitation. Coronary angiography identified significant stenotic lesions in the left main coronary artery (LMCA), left anterior descending artery (LAD), and left circumflex artery (LCX), as well as diffuse atherosclerosis in the right coronary artery (RCA). Given the extent of the disease, the patient was scheduled for coronary artery bypass grafting (CABG). The surgical approach involved complete arterial revascularization using the left internal mammary artery (LIMA), right internal mammary artery (RIMA), and a radial artery graft. The procedure was performed without complications, and postoperative monitoring showed stable hemodynamics with no signs of graft occlusion or ischemia.
Conclusion: This case highlights the benefits of complete arterial revascularization in multivessel coronary artery disease, improving surgical outcomes and recovery. While promising, further research is needed to confirm long-term benefits and refine patient selection. Individualized surgical planning and risk management remain crucial. Given the increasing prevalence of similar presentations, further case evaluations are underway to explore patterns in clinical presentation, risk stratification, and surgical outcomes.
