{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T20:10:38Z","timestamp":1784837438183,"version":"3.55.0"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronary endarterectomy with stent removal followed by arterial reconstruction is a surgical option for complex in-stent restenosis (ISR). However, this strategy generally assumes preservation of the coronary adventitia, and management of adventitial loss during stent removal has rarely been described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 67-year-old man on haemodialysis presented with exertional angina 1 year after percutaneous coronary intervention to the left anterior descending artery (LAD). Coronary angiography demonstrated severe ISR of the LAD with complex multivessel disease, and urgent off-pump coronary artery bypass grafting was performed. During coronary endarterectomy with stent removal, dense adhesion between the stent and vessel wall caused unavoidable loss of the coronary adventitia over a 10\u2005mm segment. A longitudinally opened saphenous vein graft (SVG) was used as an adventitial substitute (\u2018flooring\u2019) to reconstruct the LAD, followed by bypass using an in situ left internal thoracic artery with an onlay patch technique. The postoperative course was uneventful, and follow-up angiography confirmed excellent graft patency. The patient remained asymptomatic at 3-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights a salvage technique for unexpected adventitial loss during coronary stent removal. The use of a SVG as an adventitial substitute\u2014the \u2018flooring\u2019 concept\u2014combined with arterial onlay reconstruction may represent a feasible option in selected patients with complex ISR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag496","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:49:49Z","timestamp":1783511389000},"source":"Crossref","is-referenced-by-count":0,"title":["Coronary artery bypass surgery with stent removal and coronary endarterectomy using a saphenous vein graft as an adventitial substitute (\u2018flooring\u2019) for reconstruction of the left anterior descending artery: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0669-9391","authenticated-orcid":false,"given":"Mayu","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Kawasaki Saiwai Hospital , 31-27 Omiya-cho, Saiwai-ku, Kawasaki, Kanagawa 212-0014 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3834-2964","authenticated-orcid":false,"given":"Takahide","family":"Yoshio","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Kawasaki Saiwai Hospital , 31-27 Omiya-cho, Saiwai-ku, Kawasaki, Kanagawa 212-0014 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6183-1486","authenticated-orcid":false,"given":"Kenji","family":"Wada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, JR Tokyo General Hospital , 2-1 Yoyogi, Shibuya-ku, Tokyo 151-8528 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8875-0142","authenticated-orcid":false,"given":"Tomoya","family":"Uchimuro","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Kawasaki Saiwai Hospital , 31-27 Omiya-cho, Saiwai-ku, Kawasaki, Kanagawa 212-0014 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichiro","family":"Takanashi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Kawasaki Saiwai Hospital , 31-27 Omiya-cho, Saiwai-ku, Kawasaki, Kanagawa 212-0014 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"2026072315363617500_ytag496-B1","first-page":"431","article-title":"Coronary endarterectomy for diffusely diseased coronary artery: an ace in the hole in coronary artery surgery","volume":"10","author":"Tamariz","year":"2021","journal-title":"JTCVS Tech"},{"key":"2026072315363617500_ytag496-B2","first-page":"521","article-title":"Coronary endarterectomy: current practice and outcomes","volume":"19","author":"Soylu","year":"2014","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2026072315363617500_ytag496-B3","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur Heart J"},{"key":"2026072315363617500_ytag496-B4","first-page":"89","article-title":"Pseudoaneurysms and the role of the adventitia: definitions, pathophysiology, and imaging features","volume":"22","author":"Saad","year":"2005","journal-title":"Semin Intervent Radiol"},{"key":"2026072315363617500_ytag496-B5","first-page":"194","article-title":"Triggers, targets and treatments for thrombosis","volume":"28","author":"Mackman","year":"2008","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"2026072315363617500_ytag496-B6","first-page":"1","article-title":"Morphologic and functional differences between arterial and venous grafts used in coronary artery bypass surgery","volume":"81","author":"Kopjar","year":"2022","journal-title":"Folia Morphol (Warsz)"},{"key":"2026072315363617500_ytag496-B7","first-page":"588","article-title":"No-touch\u2019 saphenous vein grafts and the role of the vasa vasorum in graft patency","volume":"44","author":"Dashwood","year":"2013","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag496\/68738372\/ytag496.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/7\/ytag496\/68738372\/ytag496.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/7\/ytag496\/68738372\/ytag496.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T19:36:45Z","timestamp":1784835405000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag496\/8729013"}},"subtitle":[],"editor":[{"given":"Can","family":"Gollmann-Tepek\u00f6yl\u00fc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Ahmed Taha","family":"Sahin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Jamol","family":"Uzokov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":7,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag496","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]},"article-number":"ytag496"}}