Catheter-based infrared light scanner as a tool to assess conduit quality in coronary artery bypass surgery

Autor: M. Samir Jafri, Nicholas S. Burris, Richard N. Pierson, Michael H. Kwon, Cha Min Tang, Junyan Gu, Joseph M. Schmitt, Kimberly Schwartz, Robert S. Poston, Emile N. Brown, Ozeki Toshinaga, Jamie Brown
Rok vydání: 2007
Předmět:
Male
Pulmonary and Respiratory Medicine
Thorax
Cardiac Catheterization
medicine.medical_specialty
Intimal hyperplasia
Infrared Rays
Coronary Artery Bypass
Off-Pump
Enzyme-Linked Immunosorbent Assay
Internal thoracic artery
Coronary Angiography
Sensitivity and Specificity
Cohort Studies
Coronary artery bypass surgery
medicine.artery
Biopsy
medicine
Humans
Saphenous Vein
Radial artery
Vein
Vascular Patency
Aged
Retrospective Studies
Observer Variation
medicine.diagnostic_test
business.industry
Biopsy
Needle
Coronary Stenosis
Graft Occlusion
Vascular
Middle Aged
medicine.disease
Catheter
surgical procedures
operative
medicine.anatomical_structure
Radial Artery
Tissue and Organ Harvesting
cardiovascular system
Female
Surgery
Radiology
Cardiology and Cardiovascular Medicine
business
Tomography
Optical Coherence
Zdroj: The Journal of Thoracic and Cardiovascular Surgery. 133:419-427
ISSN: 0022-5223
Popis: Objectives Endothelial disruption within saphenous vein and radial artery grafts increases thrombosis risk. However, no clinically applicable method for imaging the intima currently exists. We used a novel infrared imaging technology, optical coherence tomography (OCT; LightLab Imaging, Inc, Westford, Mass), to visualize the intima within harvested conduits. Methods Conduits were procured endoscopically (37 saphenous vein grafts and 8 radial artery grafts) or with the open technique (9 radial artery grafts) from 50 patients. Surplus segments were analyzed by means of OCT for evidence of preexisting pathology or traumatic injury. Focal plaques in radial artery grafts and the intimal hyperplasia area in saphenous vein grafts were quantified as having an intimal/medial thickness ratio of greater than 0.5. Biopsy specimens were obtained for histologic confirmation and to analyze matrix metalloproteinase 2 levels (saphenous vein grafts) and prostacyclin/nitric oxide metabolites (radial artery grafts). Interobserver κ coefficients and a Bland–Altman analysis were used to determine the reproducibility and accuracy of OCT interpretations. Results Radial artery imaging revealed plaque in 76%. Endoscopically harvested vessels showed intraluminal clot (38%) and intimal tears ranging from severe (6%) to mild (88%). In saphenous vein grafts intimal thickening was detected in 86% and intraluminal clotting in 68%. The intimal/medial thickness ratio determined by means of OCT correlated directly with matrix metalloproteinase 2 levels ( R = 0.6804) in saphenous vein grafts and inversely with metabolites of prostacyclin ( R = −0.55) and nitric oxide ( R = −0.58) in radial artery grafts. OCT imaging was reproducible (interobserver κ coefficients of >0.81 for the characterization of plaque types) and showed a strong correlation with histology ( R = 0.8, P Conclusions OCT imaging provides an accurate, real-time, and reproducible means for assessing saphenous vein graft and radial artery graft bypass conduits. As a quality assurance tool, this technology might afford a more objective basis for conduit selection.
Databáze: OpenAIRE
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