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Intraoperative coronary angioscopy--technique and results: a study of 38 patients
J P Bessou1, J Melki, F Bouchart
1Department of Thoracic, Cardiac and Vascular Surgery, Charles Nicolle Hospital, Rouen, France.
Insights
Intraoperative angioscopy in coronary artery bypass surgery revealed few significant stenoses but identified potential graft issues. Improvements in angioscope technology are needed to reduce arterial damage during these cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
Background:
- Coronary artery revascularization is a critical procedure for managing coronary artery disease.
- Intraoperative angioscopy offers direct visualization of coronary arteries and grafts during surgery.
Purpose of the Study:
- To evaluate the utility of intraoperative angioscopy in assessing coronary artery bypass grafts and anastomoses.
- To identify potential lesions and technical issues within the internal thoracic arteries and distal anastomoses.
Main Methods:
- Intraoperative angioscopy was performed on 38 patients undergoing coronary artery revascularization over 11 months.
- Exploration of coronary arteries, internal thoracic arteries, and distal anastomoses was conducted using angioscopy.
Main Results:
- Thirty-three percent of observed lesions were significant stenoses.
- Forty-seven percent of distal anastomoses were explored, with no technical failures identified.
- One internal thoracic artery graft was rejected due to an intimal fracture; minor intimal flaps were noted, likely iatrogenic but not impacting outcomes.
Conclusions:
- Intraoperative angioscopy shows promise for preoperative graft assessment and distal anastomosis control.
- Improving angioscope and catheter flexibility is crucial to minimize iatrogenic arterial trauma.
Abstract:
Over a period of 11 months, 38 patients submitted to coronary artery revascularization underwent intraoperative angioscopy of the coronary arteries and internal thoracic arteries. Fifty-nine lesions were observed, but only 31 stenoses responsible for coronary insufficiency were observed (33%). Forty-four distal anastomoses were explored (47%) but ten of these explorations were incomplete. None revealed technical failure of the anastomosis. Thirteen harvested left internal mammary arteries were explored. One of the explorations led to rejection of the graft due to an intimal fracture. Some tiny intimal flaps were observed in our experience, as in others. Although the iatrogenic origin of these lesions in relation to the introduction of the angioscope is obvious, it does not seem to influence the outcome of the operation. In our opinion, two main fields appear to be developing in coronary angioscopy: preoperative assessment of the quality of internal thoracic artery grafts, and control of distal graft anastomoses. The flexibility of the angioscopes and of the leading catheters must be improved to minimize the risk of arterial wall traumatic lesions.