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Published on: March 27, 2018
Coronary bypass graft patency cannot be determined by multidetector spiral computed tomography
Kristian Bartnes1, Trude Sildnes, Amjid Iqbal
1Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, Tromsø, Norway. kristian.bartnes@unn.no
Insights
Sixteen-slice multidetector computed tomography (MDCT) cannot replace selective angiography for coronary bypass graft patency assessment. MDCT had a 24% non-evaluable rate and a 6% error rate in this study.
Area of Science:
- Cardiovascular Imaging
- Radiology
Background:
- Selective catheterization angiography is the gold standard for coronary bypass graft patency but poses risks.
- Coronary artery bypass grafting (CABG) requires reliable graft patency assessment.
Purpose of the Study:
- To evaluate if 16-slice multidetector computed tomography (MDCT) can serve as a substitute for selective angiography in assessing coronary bypass graft patency.
Main Methods:
- 45 patients underwent both MDCT and selective angiography 2-3 years post-CABG.
- A total of 156 grafts (single and sequential) were analyzed and classified as patent, stenotic, or occluded.
Main Results:
- MDCT showed a high likelihood ratio for detecting occlusion.
- However, 24% of distal anastomoses were unevaluable by MDCT due to artifacts and small vessel size.
- MDCT misclassified 6% of evaluable grafts.
Conclusions:
- 16-slice MDCT is currently not a suitable replacement for selective angiography in coronary bypass graft assessment.
- The high non-evaluable rate and error rate preclude its use as a definitive diagnostic tool.
Objectives:
Angiography by selective catheterization is the reference standard for coronary bypass graft patency assessment but carries a risk of serious complications. We have investigated whether 16-slice multidetector spiral computed tomography (MDCT) can substitute for selective angiography.
Design:
Two to three years after coronary artery bypass grafting, 45 patients with a total of 156 bypasses (100 single and 28 sequential grafts) were examined with both MDCT and conventional selective angiography on the same day. The bypasses were classified as patent, stenotic or occluded.
Results:
The likelihood ratio for MDCT-detected occlusion was 40, reflecting a fairly high combined sensitivity and specificity. However, 24% of the distal anastomoses could not be evaluated by MDCT, mainly because of respiratory movements, artifacts due to metal clips, and small vessel dimensions. Moreover, seven out of 117 bypasses (6%) deemed evaluable by MDCT were wrongly classified by this method.
Conclusions:
At present, 16-slice MDCT cannot replace selective angiography for assessment of coronary bypass graft patency since 24% of bypasses could not be evaluated by this method, and an error rate of 6% is unacceptable.
