Qiao En, Wang Yuetang, Yu Jun, Wang Xu, Luo Xinjin, Wang Wei
Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
J Cardiothorac Surg. 2021 Apr 17;16(1):93. doi: 10.1186/s13019-021-01465-3.
The clinical use of the radial artery (RA) in coronary artery bypass grafting (CABG) is still limited worldwide, although it has been recommended by several guidelines. Multidetector computed tomography (MDCT) is widely used to evaluate graft patency, as invasive coronary angiography could cause potentially serious risks including bleeding, dissection and stroke. This study aims to report the short-term results of the RA in CABG with MDCT.
The study population consists of 41 consecutive patients undergoing elective CABG with the RA graft between 2017 to 2018, with MDCT performed to evaluate graft patency during follow-up, and target vessels for the RA were non-left anterior descending coronary arteries with > 70% stenosis.
A total of 150 grafts were assessed by MDCT during follow-up (mean, 8.9 ± 5.1 months). MDCT could clearly show the structure and patency of grafts, even for complex coronary artery revascularization. Graft patency of the left internal mammary artery was 92.9% (39/42), with the RA patency of 84.4% (38/45) and the patency of the saphenous vein graft of 81.1% (30/37). And the RA anastomosed to the left coronary artery system might have better patency than the RA anastomosed to the right coronary artery system (25/29, 86.2% vs 13/16, 81.3%, p = 0.686).
The short-term patency rate of RA grafts is good, and the RA might be associated with better patency when anastomosed to the left but not the right coronary artery. MDCT could provide excellent visualization of grafts in CABG.
尽管多项指南推荐使用桡动脉（RA）进行冠状动脉旁路移植术（CABG），但其在全球范围内的临床应用仍然有限。多排螺旋计算机断层扫描（MDCT）被广泛用于评估移植血管通畅情况，因为有创冠状动脉造影可能会导致包括出血、夹层和中风在内的潜在严重风险。本研究旨在报告采用MDCT评估CABG中RA的短期结果。
研究对象为2017年至2018年间连续41例行择期CABG并使用RA移植物的患者，在随访期间进行MDCT以评估移植血管通畅情况，RA的靶血管为狭窄程度>70%的非左前降支冠状动脉。
随访期间，MDCT共评估了150条移植血管（平均8.9±5.1个月）。MDCT能够清晰显示移植血管的结构和通畅情况，即使是对于复杂的冠状动脉血运重建。左乳内动脉移植血管通畅率为92.9%（39/42），RA通畅率为84.4%（38/45），大隐静脉移植血管通畅率为81.1%（30/37）。并且，吻合至左冠状动脉系统的RA可能比吻合至右冠状动脉系统的RA具有更好的通畅率（25/29，86.2%对13/16，81.3%，p=0.686）。
RA移植物的短期通畅率良好，并且当RA吻合至左冠状动脉而非右冠状动脉时，其通畅率可能更高。MDCT能够很好地显示CABG中移植血管的情况。
