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Coronary Artery Bypass Surgery After Transradial Catheterization: Implementing 2021 ACC/AHA/SCAI Revascularization

Mario Gaudino1, Celina M Yong2,3, David Chadow1

  • 1Weill Cornell Medicine, Department of Cardiothoracic Surgery, New York, New York, USA.

JACC. Case Reports
|January 17, 2022
PubMed

Insights

The latest guidelines suggest using the radial artery for coronary angiography and bypass grafting. However, this case highlights a patient unable to receive radial artery grafts due to bilateral radial artery access.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • The 2021 ACC/AHA/SCAI guidelines advocate for radial artery (RA) access in coronary angiography.
  • RA grafting is recommended over saphenous vein grafting for coronary artery bypass grafting (CABG).

Observation:

  • A patient underwent coronary angiography utilizing both radial arteries.
  • This bilateral RA access precluded the use of RAs for subsequent CABG.

Findings:

  • Bilateral radial artery utilization for diagnostic angiography presents a contraindication for radial artery harvesting in CABG.
  • This scenario limits surgical options and adherence to current revascularization guidelines.

Implications:

  • Clinicians must consider the implications of bilateral RA angiography on future CABG options.
  • Alternative grafting strategies may be necessary for patients with bilateral RA access.
  • This case underscores the importance of pre-procedural planning for revascularization in complex cardiovascular cases.

Keywords:
ACC, American College of CardiologyAHA, American Heart AssociationCABG, coronary artery bypass graftingCAD, coronary artery diseaseDM, diabetes mellitusITA, internal thoracic arteryLAD, left anterior descending arteryLOE, level of evidenceRA, radial arterySCAI, Society for Cardiac Angiography and InterventionsSV, saphenous veinSVG, saphenous vein graftTRA, transradial accesscoronary angiographycoronary artery bypassmyocardial revascularizationpercutaneous coronary interventionradial arterytransradial approach

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