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Adams MR, Orford JL, Blake GJ, Wainstein MV, Byrne JG, Selwyn AP. Rescue percutaneous coronary intervention following coronary artery bypass graft--a descriptive analysis of the changing interface between interventional cardiologist and cardiac surgeon. Clin Cardiol 2006; 25:280-6. [PMID: 12058791 PMCID: PMC6654698 DOI: 10.1002/clc.4960250607] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite decreasing rates of acute and subacute complications of percutaneous coronary intervention (PCI), these procedures are generally only performed in centers where it is possible for failed PCI to be treated by rescue coronary artery bypass graft (CABG). Case reports and case series have documented successful PCI following failed CABG. We sought to confirm this decrease in the need for rescue CABG following failed PCI and to examine trends in the utilization of rescue PCI following failed CABG. HYPOTHESIS The interface between interventional cardiologist and cardiac surgeon is characterized by changing practice patterns and resource utilization. METHODS We examined the medical records of all patients admitted to the Brigham and Women's Hospital over a 7-year period and identified 169 patients who required both PCI and CABG during the same hospital admission. We describe and compare three predetermined groups of patients defined by the sequence of, and indication for, the relevant myocardial revascularization procedures. RESULTS In all, 100 patients required CABG for failed PCI, 46 patients had planned hybrid procedures involving both CABG and PCI, and 23 patients required PCI following failed CABG. There was a decrease in the need for rescue CABG following failed PCI, both in total numbers and as a percentage of total cases (2.5% in 1994 and 0.22% in 1999). There was a simultaneous increase in the utilization of rescue PCI following failed CABG (0% in 1994 and 1.6% in 2000). Hybrid procedures were identified as a source of innovative solutions to a variety of challenging clinical problems. CONCLUSIONS Changing patterns of resource utilization should be considered when planning hospital facilities and patient triage, and these patients undergoing percutaneous or surgical revascularization may benefit from close cooperation between the cardiac surgeon and the interventional cardiologist.
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Affiliation(s)
- Mark R. Adams
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James L. Orford
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gavin J. Blake
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marco V. Wainstein
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John G. Byrne
- Department of Cardiothoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew P. Selwyn
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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2
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Smith SC, Feldman TE, Hirshfeld JW, Jacobs AK, Kern MJ, King SB, Morrison DA, O'Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006; 47:e1-121. [PMID: 16386656 DOI: 10.1016/j.jacc.2005.12.001] [Citation(s) in RCA: 309] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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3
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Tengiz I, Aliyev E, Ercan E. An alternative percutaneous interventional approach for post-anastomatic left anterior descending artery stenosis in patients with markedly tortuous LIMA graft. Int J Cardiovasc Imaging 2006; 21:491-4. [PMID: 16175436 DOI: 10.1007/s10554-005-0369-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 01/10/2005] [Indexed: 10/25/2022]
Abstract
Percutaneous coronary intervention through a tortuous left internal mammary artery (LIMA) graft, especially with redundancy in length is a challenge in spite of availability of different types of coated guidewires and low-profile balloons. Various modifications of the interventional technique are required in order to negotiate the tortuosity of the LIMA graft. We describe an alternative technique that overcomes this problem in patient with a markedly tortuous LIMA graft.
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Affiliation(s)
- Istemihan Tengiz
- Department of Cardiology, Central Hospital, 35010, Bayrakli, Izmir, Turkey.
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4
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Izumi C, Hayashi H, Ueda Y, Matsumoto M, Himura Y, Gen H, Konishi T. Late regression of left internal thoracic artery graft stenosis at the anastomotic site without intervention therapy. J Thorac Cardiovasc Surg 2005; 130:1661-7. [PMID: 16308013 DOI: 10.1016/j.jtcvs.2005.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 07/07/2005] [Accepted: 07/19/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Intervention therapy has been recently performed on the left internal thoracic artery graft stenosis. The purpose of this study was to evaluate the natural course of the left internal thoracic artery graft stenosis at the anastomotic site and clarify whether intervention therapy should be performed early after surgery. METHODS We investigated early angiographic results of the left internal thoracic artery graft in 343 consecutive patients who underwent coronary bypass surgery. In 100 of 343 patients who underwent follow-up angiography, the graft diameter and percentage diameter stenosis at the anastomotic site were compared between early postoperative and follow-up angiography. None of these patients underwent intervention therapy on the left internal thoracic artery graft. RESULTS Of 343 patients, 46 showed 50% or greater diameter stenosis, and 20 showed 70% or greater diameter stenosis at the anastomotic site. In the 100 patients with follow-up angiography, the graft diameter significantly increased (1.8 +/- 0.4 vs 2.1 +/- 0.5 mm, P < .0001) at follow-up angiography. The percentage diameter stenosis significantly decreased (69% +/- 13% vs 35% +/- 20%, P < .0001) at follow-up angiography in the patients with 50% or greater diameter stenosis at early postoperative angiography. Regression of left internal thoracic artery graft stenosis was detected in most patients with 70% or greater diameter stenosis. CONCLUSIONS Our study demonstrated that left internal thoracic artery graft stenosis at the anastomotic site at early postoperative angiography might improve without intervention therapy. We should consider the natural course of the left internal thoracic artery graft stenosis in determining the indication of intervention therapy early after surgery.
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Affiliation(s)
- Chisato Izumi
- Department of Cardiology, Tenri Hospital, Nara, Japan.
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5
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Marx R, Klein RM, Horlitz M, Ketteler T, Schannwell CM, Lapp H, Gülker H. Angioplasty of the internal thoracic artery bypass-graft an alternative to reoperation. Int J Cardiol 2004; 94:143-9. [PMID: 15093972 DOI: 10.1016/j.ijcard.2003.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2002] [Revised: 04/11/2003] [Accepted: 04/13/2003] [Indexed: 11/18/2022]
Abstract
BACKGROUND This review presents an overview of interventional revascularization procedures of the internal thoracic artery after prior implantation as a coronary-artery bypass graft. METHODS Our search was concentrated on the MEDLINE-database to identify all articles on internal thoracic artery-graft-angioplasties and reoperation after internal thoracic artery bypass grafting published between 1968 and 2000. RESULTS Surgical revascularization and reoperation were reported in five papers including a total of 785 patients. The overall mortality of these patients was 4.2%. The presence of a patent internal thoracic artery-graft at the time of reoperation was not a risk factor for higher morbidity and mortality. Revascularization with percutaneous transluminal coronary angioplasty of the internal thoracic artery or the native left anterior descending artery via the internal thoracic artery-graft used as a conduit was performed in 327 patients. The primary success rate was 87%, the angiographically assessed rate of restenosis was 30% and the rate of complications approximately 1%. CONCLUSIONS In spite of technical problems the percutaneous transluminal coronary angioplasty in or via internal thoracic artery-graft presents a safe and feasible option to be recognized before a potential reoperation.
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Affiliation(s)
- Roger Marx
- Heart Center Wuppertal, Department of Cardiology, University of Witten-Herdecke, Gotenstrasse 1, 42653 Solingen, Germany.
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6
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Köckeritz U, Reynen K, Knaut M, Strasser RH. Results of angioplasty (with or without stent) at the site of a narrowed coronary anastomosis of the left internal mammary artery graft or via the internal mammary artery. Am J Cardiol 2004; 93:1531-3. [PMID: 15194028 DOI: 10.1016/j.amjcard.2004.02.067] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Revised: 02/24/2004] [Accepted: 02/24/2004] [Indexed: 11/15/2022]
Abstract
During the past 6 years, 50 patients underwent percutaneous transluminal coronary angioplasty (PTCA) of a narrowed coronary anastomosis of a left internal mammary artery (LIMA) graft or PTCA of a left anterior descending coronary artery stenosis via LIMA grafts at the investigators' institution. The success rate was high at 88%. Thirty-four of the 44 successfully treated patients (77%) underwent repeat angiography, which showed restenosis in 14 patients (41%). In cases of stent implantation at the coronary LIMA graft anastomosis angioplasty site, the restenosis rate was 80%, but it was only 14% in cases of pure balloon dilation (p = 0.001). Therefore, in cases of coronary LIMA graft anastomosis, stent implantation should be avoided, because it implicates an excessively high restenosis rate.
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Affiliation(s)
- Ulrich Köckeritz
- Department of Internal Medicine II, University of Dresden, Heart Center Dresden, Dresden, Germany
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7
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Sharma AK, McGlynn S, Apple S, Pinnow E, Canos DA, Gevorkian N, Tebeica M, Gruberg L, Pichard AD, Lindsay J. Clinical outcomes following stent implantation in internal mammary artery grafts. Catheter Cardiovasc Interv 2003; 59:436-41. [PMID: 12891602 DOI: 10.1002/ccd.10580] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We evaluated our experience with percutaneous coronary intervention (PCI) of internal mammary artery (IMA) grafts. From the institution's database we identified 288 patients with 311 IMA lesions. Of these, 82 (26.4%) had stents placed during PCI. Angiographic success was 92%. Mortality at 1 month was 1.7%, myocardial infarction (MI) 15.7%, and target lesion revascularization (TLR) 0.4%. Cumulative 1-year event rates were mortality 6.4%, MI 20.4%, and TLR 8.0%. TLR rates were significantly higher in the stented lesions than lesions treated with angioplasty alone (19.2% vs. 4.9%; P = 0.004). The higher TLR rate in stented lesions was most apparent at the anastomotic site (25.0% vs. 4.2%; P = 0.006). Percutaneous revascularization of IMA grafts can be performed safely with high procedural success and excellent short- and long-term results. Stenting, particularly at the anastomotic site, was associated with significantly greater rates of TLR than angioplasty alone.
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Affiliation(s)
- Arvind K Sharma
- Department of Cardiology, Washington Hospital Center, Washington, DC 20010, USA
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8
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Warner JJ, Gehrig TR, Behar VS. The VB-1 catheter: an improved catheter for difficult-to-engage internal mammary artery grafts. Catheter Cardiovasc Interv 2003; 59:361-5. [PMID: 12822160 DOI: 10.1002/ccd.10526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
As patients with prior coronary artery bypass grafting age, internal mammary artery grafts are more frequently encountered in the cardiac catheterization laboratory. Angiography and interventions involving these grafts are often difficult, particularly in patients with tortuous subclavian anatomy and/or proximal internal mammary artery origins. We describe a new catheter shape, the Cordis Behar Internal Mammary, VB-1, which allows selective intubations of both right and left internal mammary arteries that are not possible with conventional catheters.
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Affiliation(s)
- John J Warner
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
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9
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Sharma AK, Ajani AE, Garg N, GebreEyesus A, Varghese J, Pinnow E, Waksman R, Pichard AD, Lindsay J. Percutaneous interventions in radial artery grafts: clinical and angiographic outcomes. Catheter Cardiovasc Interv 2003; 59:172-5. [PMID: 12772234 DOI: 10.1002/ccd.10527] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the modern era, radial artery graft is being used with increasing frequency to replace saphenous vein as a conduit for coronary artery bypass surgery. Several reports have shown encouraging early results of radial grafts compared to saphenous grafts. Despite these advantages, radial artery graft failure requiring revascularization does occur. We report on the clinical, angiographic, and technical characteristics and the follow-up results of 22 patients who underwent percutaneous intervention of radial grafts.
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Affiliation(s)
- Arvind K Sharma
- Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
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10
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Smith SC, Dove JT, Jacobs AK, Ward Kennedy J, Kereiakes D, Kern MJ, Kuntz RE, Popma JJ, Schaff HV, Williams DO, Gibbons RJ, Alpert JP, Eagle KA, Faxon DP, Fuster V, Gardner TJ, Gregoratos G, Russell RO, Smith SC. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)31This document was approved by the American College of Cardiology Board of Trustees in April 2001 and by the American Heart Association Science Advisory and Coordinating Committee in March 2001.32When citing this document, the American College of Cardiology and the American Heart Association would appreciate the following citation format: Smith SC, Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, Kuntz RE, Popma JJ, Schaff HV, Williams DO. ACC/AHA guidelines for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty). J Am Coll Cardiol 2001;37:2239i–lxvi.33This document is available on the ACC Web site at www.acc.organd the AHA Web site at www.americanheart.org(ask for reprint no. 71-0206). To obtain a reprint of the shorter version (executive summary and summary of recommendations) to be published in the June 15, 2001 issue of the Journal of the American College of Cardiology and the June 19, 2001 issue of Circulation for $5 each, call 800-253-4636 (US only) or write the American College of Cardiology, Educational Services, 9111 Old Georgetown Road, Bethesda, MD 20814-1699. To purchase additional reprints up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1,000 or more copies, call 214-706-1466, fax 214-691-6342, or E-mail: pubauth@heart.org(ask for reprint no. 71-0205). J Am Coll Cardiol 2001. [DOI: 10.1016/s0735-1097(01)01345-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Thomas WJ, Cowley MJ, Vetrovec GW, Malloy W, Goudreau E. Effectiveness of rotational atherectomy in narrowed left internal mammary artery grafts to the left anterior descending coronary artery. Am J Cardiol 2000; 86:86-8. [PMID: 10867099 DOI: 10.1016/s0002-9149(00)00833-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- W J Thomas
- Division of Cardiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia 23298, USA
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12
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Gruberg L, Dangas G, Mehran R, Hong MK, Waksman R, Mintz GS, Kent KM, Pichard AD, Satler LF, Lansky AJ, Stone GW, Leon MB. Percutaneous revascularization of the internal mammary artery graft: short- and long-term outcomes. J Am Coll Cardiol 2000; 35:944-8. [PMID: 10732892 DOI: 10.1016/s0735-1097(99)00652-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We evaluated the short- and long-term clinical outcomes after percutaneous revascularization of the internal mammary artery (IMA) graft. BACKGROUND Previous reports in a relatively small number of patients have indicated the safety of balloon angioplasty for the treatment of stenoses in the IMA graft. However, the use of alternative interventional techniques and their long-term results have not yet been evaluated. METHODS We analyzed the in-hospital and one-year clinical outcomes of 174 consecutive patients who underwent percutaneous revascularization of 202 lesions located in the IMA graft, by either balloon angioplasty or stenting. RESULTS Anastomotic lesions were evident in 128 cases (63%), and they were more commonly treated with balloon angioplasty (116/128, 91%), whereas lesions located at the ostium (n = 16, 8%) were more frequently treated with stents (11/16, 69%). Procedural success was 97% with excellent in-hospital outcome: 0.6% mortality rate, no Q-wave myocardial infarction (MI) and 0.6% rate of urgent bypass surgery. Cumulative one-year rates were: mortality 4.4%, MI 2.9% and target lesion revascularization (TLR) 7.4%. CONCLUSIONS Revascularization of the IMA graft can be performed safely, with high procedural success and a low rate of in-hospital complications. Long-term follow-up showed very low TLR rate.
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Affiliation(s)
- L Gruberg
- Cardiovascular Research Foundation, New York 10022, USA
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13
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Blanchard D, Ztot S, Pagny JY, Boughalem K, Battaglia S, Bonnemazou A, Bar O, Nader R, Ledru F, Henry P, Baud F, Guermonprez JL. Percutaneous transluminal angioplasty of radial artery grafts. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 45:400-4. [PMID: 9863745 DOI: 10.1002/(sici)1097-0304(199812)45:4<400::aid-ccd10>3.0.co;2-i] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The radial artery is being used with increasing frequency to replace the saphenous vein as a coronary artery bypass graft, in the belief that it will provide improved long-term patency. Several centers have confirmed that the early results of surgery using the radial artery seem to be better than those obtained with saphenous grafts. Despite these apparent gains, early failure of the radial artery graft can occur and is frequently associated with symptomatic myocardial ischemia. Percutaneous angioplasty is an alternative to reoperation to treat lesions occurring on radial artery grafts. We report on 4 patients who underwent angioplasty of radial artery grafts.
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Affiliation(s)
- D Blanchard
- Hôpital Broussais, Cardiology Department, Paris, France.
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14
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Crowley ST, Bies RD, Morrison DA. Percutaneous transluminal angioplasty of internal mammary arteries in patients with rest angina. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 38:256-62. [PMID: 8804783 DOI: 10.1002/(sici)1097-0304(199607)38:3<256::aid-ccd8>3.0.co;2-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Angioplasty of the internal mammary artery (IMA) bypass graft has been shown to be a safe and effective revascularization procedure. However, angiographic and long term clinical outcomes in the high-risk group of patients presenting with rest angina has not been well documented. We report the results of IMA angioplasty in 20 patients with rest angina out of 614 (3.2%) who received a left IMA graft at our institution between April 1987 and September 1994. All patients were admitted with rest angina, 12 patients demonstrated persistent ischemia despite medical therapy, two patients were in heart failure, and one patient was in cardiogenic shock. Balloon angioplasty was successful in 15 of 20 patients (75%). Failed angioplasty was associated with either severe IMA tortuousity (three patients) or inability to cross the anastomotic stenosis with the guide wire (two patients). Each of these five patients required angioplasty of either the native left anterior descending artery or other saphenous vein grafts for clinical stabilization. No patient suffered a major complication (myocardial infarction, emergent coronary bypass surgery, death). Clinical follow-up was obtained in all 20 patients (6 months, 7 years, mean 27 months). Twelve patients (60%) were asymptomatic or had stable angina at follow-up, and 8 returned with anginal symptoms. Four patients required repeat angioplasty for disease in other vessels, two were treated medically for angina, one underwent repeat CABG, and cardiac transplantation was performed in one patient for refractory heart failure. Angiographic follow up was obtained in 10/15 (66%) successful angioplasty patients, and only one patient demonstrated restenosis at the treated site (10%). During follow up one patient developed an IMA stenosis at a previous dissection site in the body of the graft that was treated with angioplasty. These results suggest that IMA angioplasty in patients with rest angina is associated with excellent long term patency and clinical efficacy, as well as low procedural risk.
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Affiliation(s)
- S T Crowley
- Division of Cardiology, Denver Veterans Affairs Medical Center, Colorado, USA
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15
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Ishizaka N, Ishizaka Y, Ikari Y, Tamura T, Suma H, Yamaguchi T. Prolonged luminal narrowing of internal mammary artery graft after percutaneous transluminal angioplasty. Angiology 1996; 47:735-8. [PMID: 8686972 DOI: 10.1177/000331979604700717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The authors describe a case with an internal mammary artery (IMA) graft that demonstrated prolonged, but reversible, luminal narrowing persisting > twenty-four hours following percutaneous transluminal angioplasty. Luminal narrowing disappeared spontaneously, however, at the time of follow-up angiography one week after the angioplasty. Since haziness at the dilation site had been shown on preprocedural angiogram, suggestive of intraluminal thrombus, this phenomenon may be attributed to either prolonged vasospasm or distal embolization of the IMA graft.
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Affiliation(s)
- N Ishizaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
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16
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Ishizaka N, Ishizaka Y, Ikari Y, Isshiki T, Tamura T, Suma H, Yamaguchi T. Initial and subsequent angiographic outcome of percutaneous transluminal angioplasty performed on internal mammary artery grafts. Heart 1995; 74:615-9. [PMID: 8541165 PMCID: PMC484116 DOI: 10.1136/hrt.74.6.615] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To estimate the initial outcome and incidence of restenosis of angioplasty of internal mammary artery grafts in a retrospective study. METHODS The study population consisted of 46 patients (48 lesions) who underwent first balloon angioplasty within the internal mammary artery graft. Most (37/48) were at the distal anastomosis. A few (8/48) were in the graft body. Six patients with the evidence of angiographic restenosis underwent a second angioplasty. RESULTS The success rate and the restenosis rate of the first angioplasty was 73% and 30% respectively. Of the 34 patients (35 lesions) with a successful first angioplasty, 30 underwent follow up angiography with a restenosis rate of 30% (9/30). A second angioplasty was performed on six of the nine restenotic lesions, with a success rate of 83% and no restenoses. The percent diameter stenosis of the recipient native coronary artery was significantly greater in the restenosis group, at 75 (SD 27)% v 89 (17)%, p < 0.05. CONCLUSIONS First angioplasty of 46 patients (48 lesions) within an internal mammary artery graft was performed with a success rate of 73% and a restenosis rate of 30% (follow up rate of 88%). The extent of the stenosis of the recipient native coronary artery may affect the restenosis rate.
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Affiliation(s)
- N Ishizaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
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17
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Najm HK, Leddy D, Hendry PJ, Marquis JF, Richardson D, Keon WJ. Postoperative symptomatic internal thoracic artery stenosis and successful treatment with PTCA. Ann Thorac Surg 1995; 59:323-6; discussion 327. [PMID: 7847944 DOI: 10.1016/0003-4975(94)00723-k] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
From 1988 to 1992, 4,182 coronary bypass grafting procedures were performed at the University of Ottawa Heart Institute. The left internal thoracic artery (ITA) was used in 2,913 patients, the right ITA in 79, and bilateral ITAs in 61 for a total of 3,053 patients with ITAs. This study assessed patients requiring angioplasty for symptomatic ITA stenosis after operation. A total of 29 patients (0.95%) with a mean age of 55.3 +/- 1.9 years underwent angioplasty for ITA stenosis from 4 days to 34 months after operation (mean, 6.5 +/- 1.6 months). Internal thoracic artery stenosis was identified in 18 patients (62.1%) within 3 months after operation. Angina was present in 26 patients (89.7%), a positive stress test in 8 (27.6%), and myocardial infarction in 1 (3.4%). At angiography, a total of 34 stenotic sites were identified in ITA grafts. Angioplasty was successful (< 50% residual stenosis) in 31 sites (91.2%). Follow-up was available for 28 of 29 patients (96.6%) at 24.6 +/- 2.3 months. Four patients (14.3%) returned with restenosis within 3 months, 2 of whom had successful repeat angioplasty, and 1 required reoperation. Canadian Cardiovascular Society anginal class after angioplasty was less than class II in 84.6% of patients. In conclusion, symptomatic postoperative ITA stenosis is uncommon, occurs most frequently at the site of distal anastomosis, and generally presents within 3 months of operation. It may be safely and effectively treated with angioplasty with a low recurrence rate.
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Affiliation(s)
- H K Najm
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa Civic Hospital, Canada
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18
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Hadjimiltiades S, Gourassas J, Louridas G, Tsifodimos D. Stenting the distal anastomotic site of the left internal mammary artery graft: a case report. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1994; 32:157-61. [PMID: 7914832 DOI: 10.1002/ccd.1810320211] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The major problem associated with the long-term patency of the internal mammary artery graft is the early occurrence of stenosis usually at its distal anastomotic site; its management by balloon angioplasty has been associated with a high success rate. We report the case of an unsuccessful balloon angioplasty of an anastomotic stenosis of a left internal mammary artery graft that was successfully managed by stenting with one-half of a Palmaz-Schatz stent.
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Mehan VK, Meier B, Urban P. Balloon recanalisation of a chronically occluded left internal mammary artery graft. Heart 1993; 70:195-7. [PMID: 8038035 PMCID: PMC1025286 DOI: 10.1136/hrt.70.2.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A patient in whom balloon recanalisation of a chronically occluded left internal mammary artery graft was successful is described. A Magnum-Magnarail system was used, and a four month follow up showed no restenosis.
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Affiliation(s)
- V K Mehan
- Cardiology Centre, University Hospital, Geneva, Switzerland
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