Patel Pragnesh, Shammas Nicolas W, Kapalis Matthew J, Dippel Eric J, Lemke Jon, Harb Catherine
Midwest Cardiovascular Research Foundation, 1236 East Rusholme, Suite 300, Davenport, Iowa 52803, USA.
J Invasive Cardiol. 2005 Sep;17(9):479-81.
The left internal mammary (LIMA) is an ideal conduit for bypassing the left anterior descending artery (LAD) during coronary artery bypass surgery (CABG). In this study, we evaluate the frequency of significant disease in the LIMA prior to CABG and describe associated significant lateral costal branches (> 1.5 mm), subclavian disease and vertebral disease. In 115 consecutive patients referred to CABG, 101 patients met the inclusion criteria. All patients who underwent routine visualization of the LIMA vessels were reviewed and quantitatively analyzed by an independent reader. Disease in the LIMA, left subclavian and vertebral arteries were graded and considered significant if lesions were > 50%. Lateral costal branches of the LIMA were also noted for their presence and size. Of the 101 patients, 87.1% of the LIMAs prior to surgery were without any disease. One LIMA had a 25-50% narrowing and the remaining LIMAs showed 0-25% disease. Of the LIMAs, 48.5% had lateral costal branches with diameters > 1.5 mm. The incidence of significant left vertebral disease and proximal subclavian disease was 37.6% and 5%, respectively. Cardiolite stress imaging post-CABG (n = 75) showed that when ischemia persisted in the anterior wall in patients with a LIMA to the LAD, this was not associated with the presence of significant LIMA disease, lateral costal branches, or subclavian disease identified pre-operatively. We conclude that the LIMA rarely shows significant disease on routine visualization prior to CABG. Asymptomatic subclavian artery disease and the presence of lateral costal branches pre-operatively did not correlate with post-CABG ischemia in the LAD territory.
在冠状动脉旁路移植术（CABG）期间，左乳内动脉（LIMA）是绕过左前降支动脉（LAD）的理想管道。在本研究中，我们评估了CABG术前LIMA中显著病变的发生率，并描述了相关的重要外侧肋支（>1.5mm）、锁骨下病变和椎动脉病变。在115例连续转诊接受CABG的患者中，101例符合纳入标准。对所有接受LIMA血管常规可视化检查的患者进行了回顾，并由一名独立阅片者进行定量分析。LIMA、左锁骨下动脉和椎动脉的病变进行分级，若病变>50%则视为显著病变。还记录了LIMA外侧肋支的存在情况及其大小。在101例患者中，87.1%的术前LIMA无任何病变。1例LIMA有25%-50%的狭窄，其余LIMA显示0%-25%的病变。在LIMA中，48.5%有直径>1.5mm的外侧肋支。显著的左椎动脉病变和近端锁骨下动脉病变的发生率分别为37.6%和5%。CABG术后（n = 75）的心肌显像显示，当LIMA至LAD的患者前壁持续存在缺血时，这与术前确定的显著LIMA病变、外侧肋支或锁骨下病变的存在无关。我们得出结论，在CABG术前常规可视化检查中，LIMA很少显示显著病变。术前无症状的锁骨下动脉病变和外侧肋支的存在与CABG术后LAD区域的缺血无关。
