DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20191626

MSCT coronary angiography in non-invasive assessment of coronary artery bypass grafts patency

Dinesh L. Patel, Yashpal R. Rana, Megha M. Sheth, Samir G. Patel, Milin N. Garachh

Abstract


Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India and worldwide and last decade has seen a steep rise in incidence of CAD in India and its treatment as bypass surgery. Direct visualization of the grafts and native coronary arteries by invasive catheterization is now being replaced by non-invasive CT coronary angiography with higher slice machines and newer technology as it has good temporal resolution, high scanning speed as well as low radiation dose. We share our experience of graft imaging on 128 slice CT machine.

Methods: This is a retrospective, single-center, observational study. We included 500 symptomatic patients who have undergone CT study between the year 2014 to 2018 post bypass surgery.

Results: Arterial grafts have a better patency rate than venous grafts. (88% vs. 64.1%). Amongst the individual arterial grafts RIMA had the best patency rate (100%) followed by LIMA (90.8%), RA (68.7%). LAD was the most commonly involved artery (91%).

Conclusions: Significant absolute concordance between CT and catheter angiographic findings have been documented for all arterial and venous grafts patency in the literature. The MSCT with retrospective gating permits an accurate and non-invasive evaluation of patent and diseased arterial and vein grafts and could replace conventional angiography for the follow-up of symptomatic, stable patients. Moreover, an optimal diagnostic accuracy was also documented in the appraisal of native vessels distal to the graft anastomoses.


Keywords


MSCT coronary angiography, Non-invasive, Post-CABG

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References


Krishnan MN. Coronary heart disease and risk factors in India-on the brink of an epidemic?. Indian Heart J. 2012;64(4):364-7.

Frazier AA, Qureshi F, Read KM, Gilkeson RC, Poston RS, White CS. Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings. Radiographics. 2005 Jul;25(4):881-96.

Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulation. 1998;97:916-31.

Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, et al. Influence of the internal mammary artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986;314:1-6.

Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol. 1996;28:616-26.

Roy MC. Surgical-site infections after coronary artery bypass graft surgery: discriminating site-specific risk factors to improve prevention efforts. Infect Control Hosp Epidemiol. 1998;19:229-33.

Engelmann MG, von Smekal A, Knez A, Kürzinger E, Huehns TY, Höfling B, et al. Accuracy of spiral computed tomography for identifying arterial and venous coronary graft patency: Am J Cardiol. 1997;80:569-74.

Dai R, Zhang S, Lu B, Cao C, He S, Bai H, et al. Electron-beam CT angiography with three-dimensional reconstruction in the evaluation of coronary artery bypass grafts. Academic Radiology. 1998 Dec 1;5(12):863-7.

Houslay ES, Lawton T, Sengupta A, Uren NG, McKillop G, Newby DE. Non-invasive assessment of coronary artery bypass graft patency using 16-slice computed tomography angiography. J Cardiothoracic Surg. 2007 Dec;2(1):27.

Campbell PG, Teo KS, Worthley SG, Kearney MT, Tarique A, Natarajan A, et al. Non-invasive assessment of saphenous vein graft patency in asymptomatic patients: Br J Radiol. 2009;82(976):291-5.

Naveed T, Ayub M, Nazeer M, Mallick NH, Mohydin BS, Ali Z. Role of 64-slice multi detector computed tomography for non-invasive visualisation of coronary artery bypass grafts for follow up in post CABG patients: J Ayub Med Coll Abbottabad. 2010;22(2):13-9.

Luca C, Chistol R, Corciovă F, Iliescu A, Tinică G. Aortocoronary bypass graft patency assessed by coronary computed tomography angiography-unicentric study: Rev Med Chir Soc Med Nat Iasi. 2014 Oct-Dec;118(4):1054-61.

Possati G, Gaudino M, Prati F, Alessandrini F, Trani C, Glieca F, et al. Long-term results of the radial artery used for myocardial revascularization. Circulation. 2003 Sep 16;108(11):1350-4.

Yoo KJ, Choi D, Choi BW, Lim SH, Chang BC. The comparison of the graft patency after coronary artery bypass grafting using coronary angiography and multi-slice computed tomography. European J Cardio-Thoracic Surg. 2003 Jul 1;24(1):86-91.

Desai ND, Cohen EA, Naylor CD, Fremes SE. Radial artery patency study investigators. a randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Engl J Med. 2004 Nov 25;351(22):2302-9.

Khot UN, Friedman DT, Pettersson G, Smedira NG, Li J, Ellis SG. Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts: Circulation. 2004 May 4;109(17):2086-91.

Crusco F, Antoniella A, Papa V, Menzano R, Di Lazzaro D, Di Manici G, et al. Midterm follow-up of patients receiving radial artery as coronary artery bypass grafts using 16-detector-row CT coronary angiography. Radiol Med. 2007 Jun;112(4):538-49.

Collins P, Webb CM, Chong CF, Moat NE. Radial artery versus saphenous vein patency randomized trial: five-year angiographic follow-up. Circulation. 2008 Jun 3;117(22):2859-64.

Schwann TA, Zacharias A, Riordan CJ, Durham SJ, Shah AS, Habib RH. Sequential radial artery grafts for multivessel coronary artery bypass graft surgery: 10-year survival and angiography results. The Annals of thoracic surgery. 2009 Jul 1;88(1):31-9.

Hortmann HC, Oliveira HG, Rabello RR, Rocha EA, Oliveira Sternal sutures seen. CVP line noted. Comparison of patency between radial artery and saphenous vein in a coronary artery bypass grafting post-operative with return of the symptoms. Rev Bras Cir Cardiovasc. 2010 Apr-Jun;25(2):218-23.

Tranbaugh RF, Dimitrova KR, Friedmann P, Geller CM, Harris LJ, Stelzer P, et al. Radial artery conduits improve long-term survival after coronary artery bypass grafting: Ann Thorac Surg. 2010;90(4):1165-72.

Hata M, Yoshitake I, Wakui S, Unosawa S, Kimura H, Hata H, et al. Long-term patency rate for radial artery vs. saphenous vein grafts using same-patient materials. Circ J. 2011;75(6):1373-7.

Deb S, Cohen EA, Singh SK, Une D, Laupacis A, Fremes SE. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: results from RAPS (Radial Artery Patency Study): J Am Coll Cardiol. 2012;60(1):28-35.

Tsai FC, Yeh TF, Jing PL. Use of graft flow measurement and computerized tomography angiography to evaluate patency of endoscopically harvested radial artery as sequential graft in coronary artery bypass surgery. J Cardiovas Surg. 2014 Jun;55(3):415-22.