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This may indicate an increase in oxidative metabolism activity and decrease in MF edema, improvement in skeletal muscles microcirculation.
050 THE USE OF OCT TO ASSESS
PREDICTORS OF EARLY CORONARY BYPASS GRAFTS DYSFUNCTION AND ATHEROSCLEROSIS PROGRESSION IN NATIVE CORONARY ARTERIES ONE YEAR AFTER BYPASS GRAFTING
Zagorodnikov N. I., Kochergin N. A., Frolov A. V., Tarasov R. S.
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
Optical coherence tomography (OCT) is a modern method of intravascular imaging, which has adequate resolution and makes it possible to determine the thickness of the fibrous capsule of an atherosclerotic plaque. OCT also makes it possible assessing the atherosclerosis (AS) progression in vivo.
Aim. To identify predictors of early dysfunction of coronary bypass grafts (CABG), and to assess the cardioprotective properties of autografts using OCT.
Material and methods. 21 patients with chronic coronary syndrome and multiple coronary artery disease which underwent CABG were included in the one-center pilot prospective observational study. All the patients underwent CABG with OCT of arterial and venous grafts, including the distal anastomosis and the conjugate segment of the target coronary artery in the early postoperative periods after surgical myocardial revascularization and one year later (10 cases). The following parameters were assessed using OCT: endothelial integrity, presence of tortuosity,
stenosis, spasm and parietal thrombi, the ratio of conduit and native coronary artery diameters, progression of AS in grafts and native coronary arteries, dynamic changes in the state of autografts.
Results. The data of CABG and OCT of 10 patients are presented. The mean follow-up time in the postoperative period was 13,3±1,2 months. In one case, the resolution of 65% stenosis of the left internal mammary artery (LIMA) in the area of anastomosis with the left anterior descending artery (LAD) was noted due to the relief of edema (hematoma) of LIMA. In another patient, dissection of the LIMA-LAD anastomosis was discovered, while OCT revealed a double lumen with the formation of a false canal (lumen area (Sjum) =1,25 mm2) and stenosis of 70,2%. Subsequently, stenosis in the anastomotic area decreased to 49.8% with an increase in the true lumen almost twofold (Sium =2,39 mm2). In the third patient, progression of the LAD stenosis and the right coronary artery (RCA) stenosis distal to the anastomoses with a decrease in the area of the vascular lumen was noted. It is important that a greater extent of the progression of AS was observed in the RCA system, which had an anastomosis with an autovenous graft. In two patients, competing blood flow was observed between the LIMA and LAD pools, which resulted the occlusion of LIMA in one case. In one of the cases, there is a 15% stenosis decrease of obtuse marginal branch. In two cases, an increase of the lumen of the LAD by 1,5 times is noted.
Conclusion. OCT is a highly informative method for visualizing morphological changes not only in the coronary arteries, but also in coronary grafts. These changes can be associated not only with early graft dysfunction, but also with the progression of AS in the native coronary arteries within the framework of the interaction of the conduit-artery systems in the follow-up of patients.
Российский кардиологический журнал. 2021;26(S7), дополнительный выпуск (июнь)
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