Multidetector computed tomography in previous coronary artery bypass grafting: implications for secondary revascularisation.
Coronary artery bypass grafting (CABG) is the most effective revascularisation treatment for advanced coronary heart disease. Atherosclerotic disease may compromise graft patency in the follow-up. As a result, it is not unusual for patients to present with angina requiring evaluation. When present, graft disease or progression of the disease in native vessels can be treated by means of percutaneous coronary intervention (PCI) or by repeated bypass surgery. The utility of modern helical ultrafast multidetector computed tomography (MDCT) in the evaluation of the patency of arterial or vein coronary grafts and thereby avoiding the need of a coronary angiography (CA) in the majority of patients is well established using 16 or 64-slice scanners. Although the accuracy of MDCT in the study of native coronary vessels in operated patients is more challenging, modern multislice computed tomography technology (64-slice) is especially useful in the non-invasive evaluation of patients with previous CABG with chest pain or equivalent symptoms, but with inconclusive or contradictory results in exercise or pharmacological stress tests. MDCT emerges as an attractive imaging technique, not only in the study of symptomatic patients with previous CABG, but also in the planning of secondary revascularisation procedures, either percutaneous, surgical or hybrid procedures.
Marcos-Alberca
Pedro
P
Unidad de Imagen Cardiovascular, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain. pmarcosa.hcsc@salud.madrid.org
Zamorano
José Luis
JL
Escaned
Javier
J
Pozo-Osinalde
Eduardo
E
Fernández-Golfín
Covadonga
C
Macaya
Carlos
C
D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012086:Reoperation; D036542:Tomography, Spiral Computed; D017211:Treatment Failure; D014654:Vascular Patency