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Intracoronary ultrasound-guided CABG in patients with angiographically noncritical lesions. Cardiovascular Surgery
J S Pirolo1, J L Fredi, T A Shuman
1Cardiovascular Surgery Associates, St. Thomas Hospital, Nashville, Tennessee 37205, USA.
Insights
Intracoronary ultrasound accurately identifies critical coronary artery disease in patients with unclear angiograms. This imaging technique guides successful bypass surgery, relieving angina and improving heart function.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Surgery
Background:
- Coronary angiography may underestimate stenosis severity in some patients with angina and ischemia.
- Intracoronary ultrasound (ICUS) offers a more accurate assessment of lesion severity.
- Discrepancies between clinical presentation and angiographic findings necessitate advanced imaging.
Purpose of the Study:
- To evaluate the utility of ICUS in patients with discordant coronary angiography and ischemia.
- To assess the effectiveness of coronary artery bypass grafting (CABG) guided by ICUS findings.
Main Methods:
- Retrospective review of eight patients with angina and positive stress tests but non-critical coronary stenoses on angiography.
- ICUS performed to assess left main or left anterior descending artery lesions.
- CABG performed based on ICUS findings, followed by clinical and stress test evaluations.
Main Results:
- ICUS revealed critical stenoses in the left main (4 patients) or proximal left anterior descending artery (7 patients).
- Mean stenosis severity: Left main 65% (ICUS) vs. 10% (angiography); LAD 75% (ICUS) vs. 30% (angiography).
- All patients experienced reduced angina and normalized stress tests post-CABG.
Conclusions:
- ICUS accurately quantifies stenosis severity in patients with misleading angiograms.
- ICUS-guided CABG effectively treats myocardial ischemia in this patient subset.
- Intracoronary ultrasound is crucial for managing complex coronary artery disease cases.
Background:
Coronary angiography is used to determine the severity of coronary artery disease; however, in a small group of patients, clinically significant angina and physiologic tests indicative of myocardial ischemia do not correlate with angiographically demonstrable critical coronary artery disease. In these patients intracoronary ultrasound may demonstrate the true severity of lesions.
Methods:
Eight patients with angina and positive stress testing but without angiographically critical left main or left anterior descending artery stenoses were retrospectively identified. After intracoronary ultrasonic demonstration of critical left main or left anterior descending artery lesions, coronary artery bypass grafting was performed. Follow-up evaluation of clinical status and repeat stress testing were carried out.
Results:
Intracoronary ultrasound demonstrated critical left main (n = 4) or proximal left anterior descending artery (n = 7) stenoses in all patients. Severity of angiographic versus intracoronary ultrasound-documented stenoses was (mean +/- standard error of the mean) 10% +/- 10% versus 65% +/- 10% for left main lesions and 30% +/- 5% versus 75% +/- 5% for left anterior descending artery lesions. After coronary artery bypass grafting all patients had decreased angina and normalization of stress testing.
Conclusions:
In patients with clinical presentations indicative of significant coronary artery disease but with angiographically noncritical lesions, intracoronary ultrasound can accurately assess the severity of stenoses. Coronary artery bypass grafting guided by intracoronary ultrasonic findings successfully treats myocardial ischemia in these patients.