Optical coherence tomography as a method for assessing the conduit-anastomosis-artery system in patients after coronary artery bypass grafting

Background. Coronary artery bypass grafting (CABG) remains the most common cardiac surgery in the world. In the long-term follow-up period after surgery, graft failure occurs in a substantial proportion of CABG conduits and is a complex pathomorphological process. Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality that allows to assess in-vivo endothelial integrity.
Aim. To substantiate the efficacy and safety of OCT assessment of the conduitanastomosis-artery system in CABG patients.
Methods. The prospective observational cohort study included 21 patients with chronic coronary artery disease who underwent CABG. 3–5 days after CABG, patients underwent OCT and angiography of arterial and vein grafts, including distal anastomosis and nearby segment of the target coronary artery. At 12-month follow-up, all patients underwent repeated OCT and angiography of the conduitanastomosis-artery system to assess the changes. The primary endpoint of the study was graft failure; secondary endpoints of the study included unplanned repeat myocardial revascularization, cardiac death, and myocardial infarction due to graft failure.
Results. At 12-month follow-up, 14.3% of graft failure and 9.5% of cases of unplanned repeated myocardial revascularization were registered. In most cases of graft failure, primary OCT revealed pronounced changes in the conduit and the native coronary artery (conduit/artery diameter ratio was more than 2 mm), whereas the diameter of the coronary artery anastomosis was less than 2.5 mm. Myocardial infarctions and death within 12 months were not registered.
Conclusion. Thus, OCT is an effective and safe intravascular imaging technique for assessing coronary arteries and the conduit-anastomosis-artery system. OCT makes it possible to identify morphological changes in coronary bypass grafts, which can predict their early failure. The conduit/artery diameter ratio greater than 2 and target coronary artery diameter less than 2.5 mm was associated with graft failure within 12 months after CABG.

1. Harskamp R.E., Lopes R.D., Baisden C.E., de Winter R.J., Alexander J.H. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg. 2013; 257:824–833. doi: 10.1097/SLA.0b013e318288c38d.

2. Kochergin N.A., Frolov A.V., Ganyukov V.I. Coronary graft failure. Ateroskleroz i Dislipidemii. 2018;4(33):25-35 (in Russian)

3. Gaudino M., Antoniades C., Benedetto U., Deb S., Di Franco A., Di Giammarco G., Fremes S., Glineur D., Grau J., He G.W., Marinelli D., Ohmes L.B., Patrono C., Puskas J., Tranbaugh R., Girardi L.N., Taggart D.P. ATLANTIC (Arterial Grafting International Consortium) Alliance. Mechanisms, Consequences, and Prevention of Coronary Graft Failure. Circulation. 2017;136(18):1749-1764. https://doi.org/10.1161/CIRCULATIONAHA.117.027597

4. Kochergin N.A., Ganyukov V.I., Zagorodnikov N.I., Frolov A.V. Optical coherence tomography of coronary grafts. Complex Issues of Cardiovascular Diseases. 2019; 8 (4S): 89-94. (in Russian) doi:10.17802/2306-1278-2019-8-4S-89-94

5. Brown E.N., Burris N.S., Gu J., Kon Z.N., Laird P., Kallam S., Tang C.M., Schmitt J.M., Poston R.S. Thinking inside the graft: applications of optical coherence tomography in coronary artery bypass grafting. J Biomed Opt. 2007t;12(5):051704. doi: 10.1117/1.2799521.

6. Bockeria L.A.1, Petrosyan K.V.1, Bockeria O.L.1, Buziashvili Yu.I.1, Losev V.V.1, Karaev A.V.1, Golubev E.P.1, Tetvadze I.V. Intraoperative optical coherent tomography - unique modality for morphologic assessment of coronary artery bypass graft. Russian Journal of Thoracic and Cardiovascular Surgery. 2019. 61(4):328-336. (in Russian) doi:10.24022/0236-2791-2019-61-4-328-336

7. Feuchtner G.M., Smekal A., Friedrich G.J., Schachner T., Bonatti J., Dichtl W., Deutschmann M., Zur Nedden D. Highresolution 16-MDCT evaluation of radial artery for potential use as coronary artery bypass graft: a feasibility study. Am J Roentgenol 2005; 185:1289–1293. doi: 10.2214/AJR.04.0945.

8. Oshima A., Takeshita S., Kozuma K., Yokoyama N., Motoyoshi K., Ishikawa S., Honda M., Oga K., Ochiai M., Isshiki T. Intravascular ultrasound analysis of the radial artery for coronary artery by-pass grafting. Ann Thorac Surg 2005; 79:99–103. doi:10.1016/j.athoracsur.2004.06.084

9. Raber L., Mintz G.S., Koskinas K.C., Johnson T.W., Holm N.R., Onuma Y., Radu M.D., Joner M., Yu B., Jia H., Meneveau N., de la Torre Hernandez J.M., Escaned J., Hill J., Prati F., Colombo A., di Mario C., Regar E., Capodanno D., Wijns W., Byrne R.A., Guagliumi G.; ESC Scientific Document Group. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 2018; 39:3281–3300. doi:10.1093/eurheartj/ehy285.

10. Shiono Y., Kubo T., Honda K., Katayama Y., Aoki H., Satogami K., Kashiyama K., Taruya A., Nishiguchi T., Kuroi A., Orii M., Kameyama T., Yamano T., Yamaguchi T., Matsuo Y., Ino Y., Tanaka A., Hozumi T., Nishimura Y., Okamura Y., Akasaka T. Impact of functional focal versus diffuse coronary artery disease on bypass graft patency. Int J Cardiol. 2016; 222:16–21. doi:10.1016/j.ijcard.2016.07.052