1
|
Lundy EF, Karimi Galougahi K, Dominguez-Sulca D, Chowdhury E, Thomas SV, Porter CR, Mintz GS, Matsumura M, Maehara A, Cohen DJ, Moses JW, Shlofmitz ES, Jeremias A, West NEJ, Robinson NB, Shlofmitz RA, Ali ZA. Visualizing Inside Conduits-Intraoperative Screening of Grafts by Optical Coherence Tomography. Ann Thorac Surg 2023; 115:266-271. [PMID: 35970228 DOI: 10.1016/j.athoracsur.2022.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Saphenous vein graft (SVG) failure is a complex phenomenon, with technical, biologic, and local factors contributing to early and medium- and long-term failure after coronary artery bypass graft. Both technical and conduit factors may have significant impact on early SVG failure. DESCRIPTION We review the complex factors that play a pathogenic role in SVG failure, followed by review of the existing literature on potential utility of high-definition optical coherence tomography (OCT) in comprehensive intraoperative assessment of SVGs. EVALUATION We describe a new technique for intraoperative acquisition of OCT images in the harvested SVGs and introduce a classification system for pathologic processes that can be detected in the harvested SVG conduits by OCT. CONCLUSIONS The potential impact on early graft failure of the exclusion of segments of SVGs that are less than optimal (ie, containing fibroatheroma, retained thrombus, sclerotic valves, or procurement injury) will be examined in the randomized controlled OCTOCAB (Intraoperative Optical Coherence Tomography of the Saphenous Vein Conduit in Patients Undergoing Coronary Artery Bypass Surgery) trial.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York
| | - Jeffrey W Moses
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York
| | | | - Allen Jeremias
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York
| | | | | | | | - Ziad A Ali
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York.
| |
Collapse
|
2
|
Li Z, Tang Z, Wang Y, Liu Z, Wang G, Zhang L, Wu Y, Guo J. Assessment of radial artery atherosclerosis in acute coronary syndrome patients: an in vivo study using optical coherence tomography. BMC Cardiovasc Disord 2022; 22:120. [PMID: 35313827 PMCID: PMC8939080 DOI: 10.1186/s12872-022-02561-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Radial artery (RA) atherosclerosis in acute coronary syndrome (ACS) patients has not been systematically observed in vivo. The study aims to characterize plaque morphology and intimal hyperplasia of the RA in patients with ACS, using optical coherence tomography (OCT). Methods In this retrospective study involving 239 ACS patients underwent RA OCT without guidewire shadow, 3 groups were divided according to the following criteria: radial artery plaque (RAP) group included patients with fibrous, lipid or calcified plaque; patients without RAP were further classified into radial intimal hyperplasia (RIH) group (intima media thickness ratio [IMR] ≥ 1) or normal group (IMR < 1). The presence and characteristics of RAP and its related risk factors were identified. Results The RAP, RIH and normal groups included 76 (31.8%), 69 (28.9%) and 94 (39.3%) patients, respectively. Patients in RAP group were the oldest, compared with those in the RIH and normal groups (p < 0.001), and more frequently had triple vessel disease (p = 0.004). The percentage of plaque rupture (72.4% vs. 56.4%, p = 0.018) and calcification (42.1% vs. 27.6%, p = 0.026) at culprit lesion were significantly higher in patients with RAP than those without RAP. A total of 148 RAP were revealed by OCT, including fibrous (72, 48.6%), lipid (50, 33.8%) and calcified plaques (26, 17.6%). The microvessels were also frequently observed in the RAP group than that in RIH and normal groups (59.2% vs. 8.7% vs. 9.6%, p < 0.001). Multivariate logistic regression analysis showed that age, diabetes, and smoking history (all p < 0.05) were independent risk factors for RAP. Conclusions In terms of insights gained from OCT, RA atherosclerosis is not uncommon in ACS patients by OCT, sharing several morphological characters with early coronary atherosclerosis. Aging, diabetes, and smoking are risk factors for RAP. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02561-5.
Collapse
Affiliation(s)
- Zixuan Li
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhe Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Wang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zijing Liu
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Guozhong Wang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Libin Zhang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yongxia Wu
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jincheng Guo
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
3
|
Li Z, Tang Z, Wang Y, Liu Z, Wang S, Wang Y, Wang G, Wang Y, Guo J. Impact of prediabetes and duration of diabetes on radial artery atherosclerosis in acute coronary syndrome patients: An optical coherence tomography study. Diab Vasc Dis Res 2022; 19:14791641221078108. [PMID: 35184608 PMCID: PMC8866250 DOI: 10.1177/14791641221078108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prediabetes (PDM) and diabetes mellitus (DM) are common among acute coronary syndrome (ACS) patients. The present study evaluated the association between diabetes status and radial artery (RA) atherosclerosis using optical coherence tomography (OCT) in ACS patients. METHODS A total of 335 ACS patients who underwent RA OCT were categorized into the DM group, the PDM group, and the normal glucose metabolism (NGM) group. OCT characteristics and clinical variables were compared. RESULTS RA atherosclerotic plaques were more frequent in the PDM and DM groups than in the NGM group (38.7% vs. 33.3% vs. 16.1%, p = 0.001). Lipid and calcified plaque occurrence were significantly more common in the DM group, followed by the PDM and NGM groups (19.3% vs. 14.6% vs. 6.5%, p = 0.027; 11.8% vs. 6.5% vs. 1.1%, p = 0.009). The prevalence of microvessels in the PDM group was significantly higher (42.7% vs 23.7%, p = 0.017) than in the NGM group but was comparable to the DM group. Multivariate analysis revealed that HbA1c level and age were independent predictors of RA plaque formation and eccentric intimal hyperplasia (all p<0.05). CONCLUSIONS RA atherosclerosis characteristics differ according to diabetes status. HbA1c level could be a useful marker for RA atherosclerosis progression in ACS patients.
Collapse
Affiliation(s)
- Zixuan Li
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Zhe Tang
- Department of Cardiology, Beijing
Anzhen Hospital, Capital Medical
University, Beijing, China
| | - Yujie Wang
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Zijing Liu
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Senhu Wang
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Yuntao Wang
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Guozhong Wang
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Yuping Wang
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Jincheng Guo
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
- Jincheng Guo, Department of Cardiology,
Beijing Luhe hospital, Capital Medical University, No.82, Xinhua South Road,
Tongzhou District, Beijing 101149, China.
| |
Collapse
|
4
|
Yadava OP, Dinda AK, Mohanty BK, Mishra R, Ahlawat V, Kundu A. Is radial artery Doppler scanning mandatory for use as coronary bypass conduit? Asian Cardiovasc Thorac Ann 2015; 23:822-7. [PMID: 26071450 DOI: 10.1177/0218492315589197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Screening of the radial artery prior to harvesting as a conduit for coronary bypass may be performed clinically by the Allen test or by Doppler ultrasound. In a developing country like ours, the use of resources for Doppler studies may be questioned when Allen tests lead to a low rate of clinical sequelae. However, the rare occurrence of hand ischemia may be devastating and could justify the routine use of Doppler screening. This study aimed to address this question. METHODS One hundred patients undergoing elective coronary artery bypass grafting were screened by the modified Allen test and Doppler ultrasound for suitability of use of a radial artery conduit. After harvesting, proximal and distal segments of the radial artery were subjected to histopathological examination. RESULTS Of the 95 patients deemed suitable for radial artery grafting, 6 had mild calcification on Doppler ultrasound and 9 had calcification on histopathological examination. While Doppler showed atherosclerosis in 9 patients, only 6 had histopathological evidence of this (false-positive rate 3%). Of the 6 patients with histopathologic evidence of atherosclerosis, 2 were negative on Doppler (false-negative rate 2%). CONCLUSION Routine preoperative Doppler screening of the radial artery in the setting of limited resources is not justified. On the other hand, the time-tested Allen test which is easy to perform, interpret, and reproduce can be safely used as the sole screening test to harvest the radial artery.
Collapse
|
5
|
Staniloae CS, Korabathina R, Coppola JT. Transradial access for peripheral vascular interventions. Catheter Cardiovasc Interv 2013; 81:1194-203. [DOI: 10.1002/ccd.24608] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/02/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Cezar S. Staniloae
- Cardiovascular Division; Cardiac and Vascular Institute; New York University Medical Center; New York; New York
| | - Ravikiran Korabathina
- Division of Cardiovascular Medicine; Bayfront Cardiovascular Associates; Bayfront Medical Center; Saint Petersburg; Florida
| | - John T. Coppola
- Cardiovascular Division; Cardiac and Vascular Institute; New York University Medical Center; New York; New York
| |
Collapse
|
6
|
Dogan M, Peker RO, Donmez S, Gokalp O. Magnesium and diltiazem relaxes phenylephrine-precontracted rat aortic rings. Interact Cardiovasc Thorac Surg 2012; 15:1-4. [PMID: 22523136 DOI: 10.1093/icvts/ivs051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Perioperative vasospasm during cardiovascular surgery is a challenging problem. Several vasodilator agents are frequently utilized for its prevention in surgical practice. Magnesium and diltiazem both have known potential vasorelaxant effects. We planned to compare the efficacy of diltiazem and magnesium in relieving phenylephrine-precontracted rat aortic rings. Ten young adult female Wistar albino rats weighing 230-260 g were used in this study. The aortic rings in the organ bath equilibrated and reached their baseline tension. Precontraction was induced by 0.001 mmol/l phenylephrine and cumulative concentration-relaxation curves were obtained by consecutively increasing the addition of either diltiazem (10(-6)-0.1 mmol/l) or magnesium (0.1-10 mmol/l). The mean maximal relaxation responses observed by diltiazem and magnesium on separate aortic rings were 90 ± 3 and 53 ± 2%, respectively. The calculated EC50 of diltiazem was 0.01035 mmol/l, whereas the EC50 of magnesium was 4.064 mmol/l (P < 0.05). Both magnesium and diltiazem produced vasorelaxation on phenylephrine-precontracted rat aortic rings in this study, but the potency of diltiazem regarding the EC50 value was significantly higher than that of magnesium. Magnesium could be a candidate together with diltiazem to inhibit vasospasm on arterial grafts during coronary bypass surgery.
Collapse
|