title: Comparison of pathology of chronic total occlusion with and without coronary artery bypass graft.
abstract: OBJECTIVE
  The aim of our study was to investigate chronic total occlusion (CTO) in human coronary arteries to clarify the difference between CTO with prior coronary artery bypass graft (CABG) and those without prior CABG.
  
  
  RESULTS
  A total of 95 CTO lesions from 82 patients (61.6 ± 14.0 years, male 87.8%) were divided into the following three groups: CTO with CABG (n = 34) (CTO+CABG), CTO without CABG--of long-duration (n = 49) (LD-CTO) and short-duration (n = 12) (SD-CTO). A histopathological comparison of the plaque characteristics of CTO, proximal and distal lumen morphology, and negative remodelling between groups was performed. A total of 1127 sections were evaluated. Differences in plaque characteristics were observed between groups as follows: necrotic core area was highest in SD-CTO (18.6%) (LD-CTO: 7.8%; CTO+CABG: 4.5%; P = 0.02); calcified area was greatest in CTO+CABG (29.2%) (LD-CTO: 16.8%; SD-CTO: 12.1%; P = 0.009); and negative remodelling was least in SD-CTO [remodelling index (RI) 0.86] [CTO+CABG (RI): 0.72 and LD-CTO (RI): 0.68; P < 0.001]. Approximately 50% of proximal lumens showed characteristics of abrupt closure, whereas the majority of distal lumen patterns were tapered (79%) (P < 0.0001).
  
  
  CONCLUSIONS
  These pathological differences in calcification, negative remodelling, and presence of necrotic core along with proximal and distal tapering, which has been associated with greater success, help explain the differences in success rates of percutaneous coronary intervention in CTO patients with and without CABG.
authors.affiliation: CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sakakura
authors.affiliation: CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA.
authors.forename: Masataka
authors.initials: M
authors.lastname: Nakano
authors.affiliation: CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA.
authors.forename: Fumiyuki
authors.initials: F
authors.lastname: Otsuka
authors.affiliation: CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Yahagi
authors.affiliation: CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Kutys
authors.affiliation: CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Ladich
authors.affiliation: Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Aloke V
authors.initials: AV
authors.lastname: Finn
authors.affiliation: CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA.
authors.forename: Frank D
authors.initials: FD
authors.lastname: Kolodgie
authors.affiliation: CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA rvirmani@cvpath.org.
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
mesh_terms: D002908:Chronic Disease; D001026:Coronary Artery Bypass; D054059:Coronary Occlusion / Q000473:pathology* / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D061205:Vascular Calcification / Q000473:pathology; D066253:Vascular Remodeling / Q000502:physiology
keywords: Calcification; Chronic total occlusion; Coronary artery bypass graft; Negative remodelling; Percutaneous coronary intervention