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56th Annual Meeting Abstracts

Use of Optical Coherence Tomography to Guide the Selection of RA Conduits for CABG
Pranjal H. Desai, MD, Stanislay Henkin, MD, Alex Brown, MD, Tara Melillo, MD, Pluen Ziu, MD, Robert Ziu, MD
Boston University School of Medicine, Boston, MA

PURPOSE OF STUDY

Risks of pre-existing plaque, injury or spasm during harvest make the radial artery (RA) a controversial conduit for coronary artery bypass grafting (CABG).  We hypothesize that intraoperative imaging facilitates the selection of the most optimal RA for grafting and therefore would improve results for this conduit.

 

METHODS USED

CABG patients scheduled to receive a RA graft underwent harvest using open (n=25) or endoscopic (n=25) techniques.  RA imaging was performed in situ and ex vivo by inserting a sterile 1F optical coherence tomography (OCT) catheter into the vessel prior to and after harvest.  Images were evaluated for intimal injury, medial calcifications and retained clot.

 
 
 

SUMMARY OF RESULTS

Out of 50 imaged RA, three were not used for grafting based on OCT findings: transmural calcification (n=1)(Clip 1), severe atherosclerotic plaque (n=1), multiple intimal tears after endoscopic harvest (n=1,) (Clip 2,3). Sections of three RA with focal intimal tears were discarded but the remaining vessel was sufficient for grafting.  The remaining RA showed with no abnormalities (n=15) or defects (n=29) of uncertain importance: mild calcification (n=14), retained clot strands (n=18)(Clip4) ,plaque that is not hemodynamically significant (n=12)(Clip5), and minor intimal tears confined to branch points (n=10).
   


CONCLUSIONS

Information obtained by intraoperative imaging of RA provoked major changes in grafting strategy in 6 out of 50 cases. Further patient follow-up will define whether other minor abnormalities that were noted within grafted RA (e.g. plaques, retained clot) influence outcome.  The surprising frequency of severe abnormalities supports the development of catheter-based OCT as a CABG quality assurance tool.
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