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Quantitative assessment of coronary arterial diameter before and after coronary artery bypass grafting
R G Cigarroa1, R A Lange, L D Hillis
1Department of Internal Medicine (Cardiovascular Division), University of Texas Southwestern Medical Center, Dallas 75235.
Insights
Coronary artery bypass graft success depends on artery size. Angiograms underestimate the true size of arteries filled by collaterals before bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary artery bypass graft (CABG) patency is crucial for long-term outcomes.
- Accurate preoperative assessment of coronary artery diameter is vital for surgical planning.
- The true luminal size of arteries filled via collateral circulation is not well-defined by standard angiography.
Purpose of the Study:
- To measure and compare coronary arterial luminal diameter before and after bypass grafting.
- To investigate the accuracy of angiographic assessment in arteries supplied by collaterals.
- To determine if bypass surgery alters the perceived luminal size of bypassed coronary arteries.
Main Methods:
- Coronary angiography was performed before and 1-35 months after bypass surgery in 26 patients.
- Luminal diameters were measured for bypassed arteries, categorized by degree of stenosis and flow source (anterograde vs. collateral).
- Statistical analysis was used to compare pre- and post-operative measurements.
Main Results:
- No significant change in luminal diameter was observed for arteries with insignificant narrowing or those filled by anterograde flow.
- Coronary arteries that were occluded and filled by collateral flow demonstrated a significantly larger luminal diameter post-operation (p < 0.001).
- This indicates a consistent underestimation of true luminal size by angiography in collateral-dependent arteries.
Conclusions:
- Angiographic assessment underestimates the true luminal diameter of coronary arteries occluded and supplied by collaterals.
- Bypass grafting provides a more accurate representation of the luminal size in these specific cases.
- Preoperative imaging may need refinement for optimal planning in patients with significant collateralization.
Abstract:
Because coronary artery bypass graft patency is related to the size of the artery, a preoperative assessment of arterial diameter is important. However, the relation between coronary arterial diameter (assessed by angiography) and true luminal size of arteries that are occluded and filled by collaterals has not been completely characterized. This study was done to measure the luminal diameter of coronary arteries before and after bypass grafting. Twenty-six patients (20 men and 6 women, aged 34 to 72 years) had coronary angiography before and from 1 to 35 months after bypass surgery. Coronary arterial luminal diameter was similar before and after operation for the 18 insignificantly narrowed arteries and the 24 arteries with narrowings that filled by anterograde flow before operation and were bypassed. In contrast, in the 21 arteries that were occluded and filled by collateral flow, coronary arterial diameter was significantly larger (p less than 0.001) after operation. Thus, when a coronary artery is occluded and filled by collaterals, its true luminal size is consistently underestimated by the angiogram.