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Late regression of left internal thoracic artery graft stenosis at the anastomotic site without intervention therapy
Chisato Izumi1, Hidetaka Hayashi, Yuichi Ueda
1Department of Cardiology, Tenri Hospital, Nara, Japan. izumi-ch@tenriyorozu-hp.or.jp
Insights
Left internal thoracic artery graft stenosis at the anastomotic site may improve naturally without intervention. Early intervention therapy for left internal thoracic artery graft stenosis should consider this natural course.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Left internal thoracic artery (LITA) grafts are crucial for coronary artery bypass grafting (CABG).
- Stenosis at the LITA graft anastomotic site can occur post-CABG.
- The optimal management strategy for LITA graft stenosis remains under investigation.
Purpose of the Study:
- To evaluate the natural progression of LITA graft stenosis at the anastomotic site.
- To determine if early intervention therapy is necessary for LITA graft stenosis.
- To inform clinical decision-making regarding LITA graft stenosis management.
Main Methods:
- Retrospective analysis of 343 patients undergoing CABG with LITA grafts.
- Early postoperative and follow-up angiography performed in 100 patients.
- Comparison of graft diameter and percentage diameter stenosis at the anastomotic site between early and follow-up angiography.
Main Results:
- Significant increase in LITA graft diameter observed at follow-up angiography (1.8 +/- 0.4 mm to 2.1 +/- 0.5 mm).
- Significant decrease in percentage diameter stenosis at follow-up angiography (69% +/- 13% to 35% +/- 20%) in patients with initial stenosis >= 50%.
- Regression of stenosis was noted in most patients with initial stenosis >= 70%.
Conclusions:
- LITA graft stenosis at the anastomotic site may spontaneously improve without intervention.
- The natural course of LITA graft stenosis should be considered when deciding on early intervention.
- Conservative management may be a viable option for select cases of LITA graft stenosis.
Objective:
Intervention therapy has been recently performed on the left internal thoracic artery graft stenosis. The purpose of this study was to evaluate the natural course of the left internal thoracic artery graft stenosis at the anastomotic site and clarify whether intervention therapy should be performed early after surgery.
Methods:
We investigated early angiographic results of the left internal thoracic artery graft in 343 consecutive patients who underwent coronary bypass surgery. In 100 of 343 patients who underwent follow-up angiography, the graft diameter and percentage diameter stenosis at the anastomotic site were compared between early postoperative and follow-up angiography. None of these patients underwent intervention therapy on the left internal thoracic artery graft.
Results:
Of 343 patients, 46 showed 50% or greater diameter stenosis, and 20 showed 70% or greater diameter stenosis at the anastomotic site. In the 100 patients with follow-up angiography, the graft diameter significantly increased (1.8 +/- 0.4 vs 2.1 +/- 0.5 mm, P < .0001) at follow-up angiography. The percentage diameter stenosis significantly decreased (69% +/- 13% vs 35% +/- 20%, P < .0001) at follow-up angiography in the patients with 50% or greater diameter stenosis at early postoperative angiography. Regression of left internal thoracic artery graft stenosis was detected in most patients with 70% or greater diameter stenosis.
Conclusions:
Our study demonstrated that left internal thoracic artery graft stenosis at the anastomotic site at early postoperative angiography might improve without intervention therapy. We should consider the natural course of the left internal thoracic artery graft stenosis in determining the indication of intervention therapy early after surgery.
