scholarly journals Radial artery as a second conduit gains momentum: The RAPCO trial

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Walid Simry ◽  
Ahmed Afifi
Keyword(s):  
Coronary Artery ◽  
Radial Artery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Long Term Results ◽  
Current Evidence ◽  
Arterial Grafts ◽  
Repeat Revascularization ◽  
Internal Mammary

In coronary artery bypass grafting (CABG), the use of an internal mammary artery (IMA) to graft the left anterior descending coronary artery (LAD) improves survival and reduces the need for repeat revascularization. The other IMA, radial artery (RA), and saphenous vein (SV) have contested to complete the surgical revascularization. For that purpose, SV remains the most commonly used conduit despite current evidence in favor of arterial grafts. To determine which conduit is best for grafting the second most important coronary artery, Buxton and colleagues have recently published the long term results of their “Radial Artery Patency and Clinical Outcomes (RAPCO)” trial.

Abstract 2992: Percutaneous Coronary Intervention With Drug Eluting Stents Versus Left Internal Mammary Artery Grafting For Patients With Isolated Lesion In The Proximal Segment Of Left Anterior Desceding Coronary Artery, Suffering From Chronic Stable Angina.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sophia Vaina ◽  
Konstantinos Toutouzas ◽  
Chrysoula Patsa ◽  
Eleftherios Tsiamis ◽  
Elli Stefanadi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Stable Angina ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Chronic Stable Angina ◽  
Long Term Results ◽  
Internal Mammary ◽  
Drug Eluting ◽  
Surgical Group

Introduction: Coronary artery bypass grafting (CABG) with left internal mammary artery (LIMA) and percutaneous transluminal coronary angioplasty (PCI) with drug eluting stent (DES) implantation are both effective to treat ischemic heart disease. In the current study we evaluated the long term results of the two methods in patients (pts) with isolated proximal left anterior descending artery lesion (pLAD), suffering from chronic stable angina (CSA). Methods: We included 280 pts, 170 with DES implantation and 110 with LIMA grafting. Primary end points were the occurrence of major adverse cardiac events (MACE), defined as: Death, myocardial infarction and target vessel revascularization (TVR). Secondary end-points included the length of hospitalization, in-hospital complications and the recurrence of chest pain. Pts were followed-up clinically. Results: Mean follow-up period was two years (midrange, one to three years). MACE was 5.29% in the DES group and 2.72% in the surgical group (p=0.37). TVR was 3.52% after PCI and 0% after CABG (p=0.08). The event-free survival curve was similar between the two groups (Figure ). More in-hospital complications were observed in the surgical group compared with the PCI group (16.36% vs. 1.17%, respectively, p=0.01). Recurrent angina was 4.11% in the DES group and 6.36% in CABG group (p = 0.41). Conclusions : In the current study the two procedures had similar long-term results, even though the surgical approach was associated with increased in-hospital complications and longer hospitalization. Therefore, both revascularization modalities can be used to treat pLAD lesions in pts with CSA.

scholarly journals Topical Vasodilator Response is Significantly Higher in Skeletonized Internal Mammary Artery

2016 ◽  
Vol 9 (4) ◽  
pp. 279
Author(s):  
Nida Butt ◽  
Sarah Hamid ◽  
Mujtaba Hussain ◽  
Ali Alam ◽  
Hala Soomro ◽  
...  
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Internal Mammary ◽  
The Difference

<p><strong>AIM OF THE STUDY</strong><strong>:</strong> Coronary artery bypass graft surgery is the gold standard for the treatment of multi-vessel and left main coronary artery disease. However, there is considerable debate that whether left internal mammary artery (IMA) should be taken as pedicled or skeletonized. This study was conducted to assess the difference in blood flow after application of topical vasodilator in skeletonized and pedicled IMA.</p><p><strong>METHODS</strong><strong>: </strong>In this study, each patient underwent either skeletonized (n=25) or pedicled IMA harvesting (n=25). The type of graft on each individual patient was decided randomly. Intra-operative variables such as conduit length and blood flow were measured by the surgeon himself. The length of the grafted IMA was carefully determined in-vivo, with the proximal and distal ends attached, from the first rib to IMA divergence. The IMA flow was measured on two separate occasions; before and after application of topical vasodilator.  Known cases of subclavian artery stenosis and previous sternal radiation were excluded from the study.</p><p><strong>RESULTS</strong><strong>:</strong> The blood flow before application of topical vasodilator was similar in both the groups (<em>P</em>=0.227). However, the flow was significantly less in pedicled than skeletonized IMA after application of vasodilator (<em>P</em> &lt; 0.0001). Similarly, the length of skeletonized graft was significantly higher than the length of pedicled graft (<em>P</em> &lt; 0.0001).</p><p><strong>CONCLUSION</strong><strong>:</strong> Our study signifies that skeletonization of IMA results in increased graft length and blood flow especially after the application of topical vasodilator. However, we recommend that long term clinical trials should be conducted to fully determine long term patency rates of skeletonized IMA.</p>

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