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Bypass graft and native postanastomotic coronary artery patency: assessment with computed tomography
Daniele Andreini1, Gianluca Pontone, Giovanni Ballerini
1Centro Cardiologico Monzino, IRCCS, Institute of Cardiology, University of Milan, Milan, Italy.
Insights
Multidetector computed tomography accurately assesses coronary artery bypass grafts and native arteries. This imaging technique shows high feasibility and diagnostic value for detecting graft patency and stenosis.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Multidetector computed tomography (MDCT) is established for evaluating coronary artery bypass grafts (CABGs).
- Previous studies highlight MDCT's utility in assessing CABG patency.
- This study investigates MDCT's accuracy in detecting graft patency and stenosis in both grafts and native coronary arteries.
Purpose of the Study:
- To determine the accuracy of MDCT in evaluating coronary artery bypass grafts.
- To assess MDCT's capability in detecting significant stenosis in grafts and native coronary arteries.
- To compare MDCT findings with conventional angiography.
Main Methods:
- Ninety-six patients with 216 bypass grafts (arterial and venous) underwent 16-slice MDCT.
- Native postanastomotic coronary arteries were also evaluated.
- MDCT data were compared against conventional angiography results.
Main Results:
- MDCT demonstrated high feasibility for bypass grafts (98.1%) and postanastomotic arteries (93.1%).
- The technique correctly identified all occluded grafts (100% sensitivity) and showed high accuracy for significant stenoses.
- Patient-based analysis yielded high sensitivity (100%) and specificity (93%) for MDCT assessment.
Conclusions:
- MDCT provides accurate assessment of arterial and venous bypass grafts.
- The method is highly feasible for evaluating native coronary arteries post-anastomosis.
- Limitations include breath-hold duration and assessment of small distal vessels, impacting a small percentage of cases.
Background:
Multidetector computed tomography has been shown to be useful in the evaluation of coronary artery bypass grafts in previous studies. We studied the accuracy of multidetector computed tomography in the detection of patency and significant stenosis of both grafts and native postanastomotic coronary arteries.
Methods:
Ninety-six patients with 216 grafts (98 left mammary artery, 8 right mammary artery, 8 radial artery, and 102 venous grafts) were investigated by 16-slice computed tomography. Native postanastomotic coronary arteries were also evaluated. Patients unable to maintain a breath hold of 40 s were excluded. Computed tomography data were compared with the results of conventional angiography.
Results:
On a segment-based model, the overall feasibility of computed tomography was 98.1% (212 of 216 grafts) for bypass grafts and 93.1% (201 of 216 segments) for postanastomotic coronary arteries. The leading cause of unfeasibility for postanastomotic coronary arteries was the small diameter of the examined vessel (<1.5 mm). Computed tomography correctly diagnosed all the 25 occluded grafts. Of the 33 significant stenoses of grafts, computed tomography correctly diagnosed 31. Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 98.5%, 96.5%, and 100%, respectively, for bypass graft; and 100%, 97.7%, 85%, and 100%, respectively, for coronary arteries. On a patient-based model, the feasibility, sensitivity, specificity, positive predictive value, and negative predictive value were 89.4% (86 of 96 patients), 100%, 93%, 86.4%, and 100%, respectively.
Conclusions:
Multidetector computed tomography allows a very accurate assessment of arterial and venous conduits and of postanastomotic native coronary arteries in patients with previous bypass graft. Despite high feasibility (93.1%), limitations of the method were breath-hold duration (35 to 40 s) and postanastomotic assessment of small vessels (which, however, precluded the analysis in only 4.6% of cases).
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