Impact of coronary artery bypass grafting (CABG) on coronary collaterals in patients with a chronic total occlusion (CTO)

2021 ◽  
Author(s):  
Usaid K. Allahwala ◽  
Avedis Ekmejian ◽  
Nadeem Mughal ◽  
David Brieger ◽  
Daniel Nour ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Chronic Total Occlusion ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Total Occlusion ◽  
Artery Bypass Grafting ◽  
Coronary Collaterals

The dynamic effect of coronary artery bypass grafting on the instantaneous wave-free ratio in the collateral donor artery of a patient with chronic total occlusion

2020 ◽  
Author(s):  
Florian Rey ◽  
Sophie Degrauwe ◽  
Stéphane Noble ◽  
Juan F Iglesias
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Chronic Total Occlusion ◽  
Artery Bypass ◽  
Dynamic Effect ◽  
Bypass Grafting ◽  
Total Occlusion ◽  
Artery Bypass Grafting ◽  
Donor Artery

Abstract Physiological assessment is challenging in patients with multivessel disease (MVD) with a chronic total occlusion (CTO) and may result in inappropriate treatment decisions. We report herein, for the first time to our knowledge, on the dynamic changes of the instantaneous wave-free ratio in the CTO collateral donor artery before and after coronary artery bypass grafting (CABG). Our case highlights the paramount importance of collateral circulation when interpreting invasive indices of coronary stenosis severity to guide decision-making for CABG in MVD patients with a CTO. This may be particularly relevant to reduce the risk of early graft failure in patients with MVD undergoing CABG.

Predictors of progression of native coronary narrowing to total occlusion after coronary artery bypass grafting

2003 ◽  
Vol 91 (8) ◽  
pp. 971-974 ◽  
Author(s):  
Kyle K. Pond ◽  
Gary V. Martin ◽  
Nathan Every ◽  
Kenneth G. Lehmann ◽  
Richard Anderson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Total Occlusion ◽  
Artery Bypass Grafting

scholarly journals Clinical outcomes of complete versus incomplete revascularization in patients treated with coronary artery bypass grafting: insights from the TiCAB trial

2020 ◽  
Author(s):  
Andreas Schaefer ◽  
Lenard Conradi ◽  
Yvonne Schneeberger ◽  
Hermann Reichenspurner ◽  
Sigrid Sandner ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Chronic Total Occlusion ◽  
Artery Bypass ◽  
Random Allocation ◽  
Bypass Grafting ◽  
Total Occlusion ◽  
Repeat Revascularization ◽  
Incomplete Revascularization

Abstract OBJECTIVES In this post hoc analysis of the Ticagrelor in coronary artery bypass grafting (CABG) trial, we aimed to analyse patients treated with CABG receiving either complete revascularization (CR) or incomplete revascularization (ICR) independent from random allocation to either ticagrelor or aspirin. METHODS Of 1859 patients enrolled in the Ticagrelor in CABG trial, 1550 patients (83.4%) received CR and 309 patients (16.6%) ICR. Outcomes were evaluated regarding all-cause mortality, cardiovascular death, myocardial infarction (MI), repeat revascularization, stroke and bleeding within 12 months after CABG. RESULTS Baseline parameters revealed significant differences regarding clinical presentation (stable angina pectoris: CR 68.9% vs ICR 71.2%, instable angina pectoris: 14.1% vs 7.8%, non-ST elevation MI: 17.0% vs 21.0%, P ˂ 0.01), lesion characteristics (chronic total occlusion: CR 91.3% vs ICR 96.8%, P ˂ 0.01), operative technique [off-pump coronary artery bypass surgery (OPCAB): CR 3.0% vs ICR 6.1%, P ˂ 0.01] and number of utilized grafts (total number of grafts: 2.69/patient vs 2.49/patient, P ˂ 0.001). ICR patients displayed a significantly increased risk of repeat revascularization [hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.16–3.16; P < 0.01] and percutaneous coronary intervention (HR 1.95, 95% CI 1.13–3.35; P < 0.05) within 12 months after CABG. Higher risk for repeat revascularization in ICR patients was independent from random allocation to either ticagrelor or aspirin and persisted after adjustment for baseline imbalances. CONCLUSIONS Patients with ICR presented more stable at the time of admission, but received less grafts, highly likely due to a higher rate of chronic total occlusion lesions and performed OPCAB. Although mortality presented no difference between groups, our results suggest that patients benefit from CR with regard to prevention of repeat revascularization.

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