Dataset Information

Late spontaneous internal thoracic artery graft dissection after coronary bypass grafting: a case report.

ABSTRACT:

Background

Internal thoracic artery (ITA) grafts are commonly used for coronary artery bypass grafting, with dissection to the graft being a rare occurrence. Herein, we describe a case of spontaneous ITA graft dissection occurring 11 years after grafting, with no clear precipitating incidence.

Case summary

The patient was a 61-year-old man who presented with a 3-month history of chest pain and dyspnoea. Dissection of the left internal thoracic artery (LITA) graft was observed on angiography, with a thrombolysis in the myocardial infarction (TIMI) grade 2 blood flow. Intravascular ultrasound confirmed an intimal tear in the proximal graft, with an intramural haematoma. In the absence of atherosclerotic changes, the dissection was treated directly using multiple drug-eluting stents to prevent further extension of the intramural haematoma proximally into the subclavian artery and distally to the anastomosis site. Post-procedural angiography revealed an enlarged true lumen of the LITA, shrinking of the intramural haematoma, and improvement in blood flow to a TIMI grade 3. Chest symptoms resolved immediately after the procedure, with the patient remaining asymptomatic over the 6-month period following the procedure.

Discussion

Dissection of the ITA graft can occur spontaneously long after the initial grafting. Intravascular ultrasound is useful for diagnosis. Ensuring adequate coverage of the edges of the dissection with stenting could prevent further extension of the intramural haematoma.

SUBMITTER: Ishibuchi K

PROVIDER: S-EPMC8922694 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Publications

Late spontaneous internal thoracic artery graft dissection after coronary bypass grafting: a case report.

Ishibuchi Kasumi K Yajima Shin S Yamamoto Wataru W Otsuji Satoru S

European heart journal. Case reports 20220210 2

<h4>Background</h4>Internal thoracic artery (ITA) grafts are commonly used for coronary artery bypass grafting, with dissection to the graft being a rare occurrence. Herein, we describe a case of spontaneous ITA graft dissection occurring 11 years after grafting, with no clear precipitating incidence.<h4>Case summary</h4>The patient was a 61-year-old man who presented with a 3-month history of chest pain and dyspnoea. Dissection of the left internal thoracic artery (LITA) graft was observed on a ...[more]

PMID: 35295725

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Project description:BackgroundThe effect of diabetes mellitus (DM) on the long-term outcomes of coronary artery bypass graft (CABG) remained debatable and various strategies exist for CABG; hence, clarifying the effects of DM on CABG outcomes is difficult. The current study aimed to evaluate the effect of DM on clinical and graft-related outcomes after CABG with bilateral internal thoracic artery (BITA) grafts.MethodsFrom January 2001 to December 2017, 3395 patients who underwent off-pump CABG (OPCAB) with BITA grafts were enrolled. The study population was stratified according to preoperative DM. The primary endpoint was cardiac death and the secondary endpoints were myocardial infarction (MI), revascularization, graft failure, stroke, postoperative wound infection, and a composite endpoint of cardiac death, MI, and revascularization. Multiple sensitivity analyses, including Cox proportional hazard regression and propensity-score matching analyses, were performed to adjust baseline differences.ResultsAfter CABG, the DM group showed similar rates of cardiac death, MI, or revascularization and lower rates of graft failure at 10 years (DM vs. non-DM, 19.0% vs. 24.3%, hazard ratio [HR] 0.711, 95% confidence interval [CI] 0.549-0.925; P = 0.009) compared to the non-DM group. These findings were consistent after multiple sensitivity analyses. In the subgroup analysis, the well-controlled DM group, which is defined as preoperative hemoglobin A1c (HbA1c) of < 7%, showed lower postoperative wound infection rates (well-controlled DM vs. poorly controlled DM, 3.7% vs. 7.3%, HR 0.411, 95% CI 0.225-0.751; P = 0.004) compared to the poorly controlled DM group, which was consistent after propensity-score matched analysis.ConclusionsOPCAB with BITA grafts showed excellent and comparable long-term clinical outcomes in patients with and without DM. DM might have a protective effect on competition and graft failure of ITA. Strict preoperative hyperglycemia control with target HbA1c of < 7% might reduce postoperative wound infection and facilitate the use of BITA in CABG.

Project description:Large number of patients with prior coronary artery bypass grafting (CABG) need repeat revascularization yearly, and percutaneous coronary intervention (PCI) is the optimal treatment strategy for such patients. However, it is still controversial whether PCI of native coronary artery or bypass graft is more beneficial. The aim of the study was to compare the clinical outcomes between native coronary artery vs. bypass graft PCI in patients with prior CABG. A total of 1,276 patients with prior CABG who underwent index PCI of native coronary artery (n=1,072) or bypass graft (n=204) were retrospectively examined. Patients were divided into native group and graft group according to the target vessel. The outcomes of the two groups were compared by using inverse probability of treatment weighting (IPTW) and Cox regression analysis. The primary endpoint was the composite of major adverse cardiac and cerebrovascular events (MACCEs), which included all-cause death, non-fatal stroke, non-fatal myocardial infarction (MI), or target vessel revascularization (TVR). Compared with native group, patients in graft group had higher risk of slow-flow/no-reflow phenomenon (1.5% vs. 0.1%, P=0.011 before IPTW, and 2.2% vs. 0.1%, P<0.001 after IPTW) and peri-procedural stroke (0.3% vs. 0, P=0.021 after IPTW). During a median follow-up period of 43 months, there was similar risk of MACCE between two groups. Notably, patients in graft group had a significantly higher incidence of non-fatal MI compared with native group regardless with or without IPTW (7.8% vs. 3.8%, P=0.018 and 8.3% vs. 3.9%, P=0.030, separately). After adjusting for confounding by using Cox regression, bypass graft PCI was associated with a higher risk of non-fatal MI (HR: 2.091, 95% CI: 1.069-4.089; P=0.031), but similar results in MACCE (HR: 1.077, 95% CI: 0.817-1.419; P=0.599) compared with native group. This study found that native coronary artery might be preferred for PCI in patients with prior CABG because of lower rates of slow-flow/no-reflow, peri-procedural stroke, and non-fatal MI at follow-up.

Dataset Information

Late spontaneous internal thoracic artery graft dissection after coronary bypass grafting: a case report.

Background

Case summary

Discussion

Publications

Late spontaneous internal thoracic artery graft dissection after coronary bypass grafting: a case report.

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