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 |
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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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