department of imaging diagnostic national cardiovascular ... · graft anatomy - shape and borders...
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Department of Imaging DiagnosticNational Cardiovascular Hospital, Sofia
E.Valcheva
Why Image Post CABG
Early and late graft disease- Up to 12% of vein grafts occluded before discharge- 50% of vein grafts occluded at 10 years- 17% of mammary artery grafts occluded at 10 years
Disease progression in non grafted arteries- 40% over 10 years
Pre-op evoluation for CABG reoperations
Why MDCT
• Advanced age
• Generalized atherosclerotic disease
• Comorbidity
• Risk of angiography is higher
Indication for MDCT after CABGs
Asymptomatic patients
Patients with atypical chest pain
Patients with mismatching stress test (ECG and nuclear medicine)
CT Assessment After CABGs
Graft anatomy- Shape and borders of the vessel
- To distinguish side of the anastomosis
- Measurement of bypass diameter
Distal anastomosis
Origin LIMA
Distal Vessels
CT Assessment After CABGs
Graft anatomyPatency
CT Assessment After CABGs
Graft anatomyPatencyStenosis /OcclusionProgression of disease in
native coronary arteries
LAD
Detection of Native Coronary Artery Stenosis by CT After CABG
Study CTPatients, n
Excl,%
Sens,% Spec,% PPV,% NPV,% Acc,%
Nieman et al 4 24 31,34 90,79 75,72 81,73 86,79 83,76
Stauder etal 16 20 31 92 77 86 85 87
Salm et al 16 25 26 100 89 85 100 93
Malaguitti et al
64 52 0 92 71 65 99 81
Ropers et al 64 50 9 86 76 44 96 73
CT Assessment After CABGs
Graft anatomyPatencyStenosis /Occlusion- More common SVG- IMA rare more
common when grafted vessel narrows
CT Assessment After CABGs
Graft anatomyPatencyStenosis /Occlusion
Graft aneurysm formation- Pseudoaneurysms occur
at anastomoses- True aneurysms occur
mid-graft, >5yrs
CT Assessment After CABGs
Graft anatomyPatencyStenosis /OcclusionProgression of disease in
native coronary arteriesReoperation PlanningMyocardial function and
morfology (thickness, thickening and perfusion) EF – 41%; EDV – 288
ml; ESV – 169 ml; SV -110 ml; CO – 7.31/min.
CT Assessment After CABGs
Graft anatomyPatencyStenosis /OcclusionProgression of disease in
native coronary arteries
Reoperation Planning
MDCT Diagnostic Accuracy in Evaluating all CABG and Native Postanastomotic Coronary Arteries
CABG Native CpronaryArteries
Sensitivity,% 100% 100%
Speciiicity,% 98,5% 97,7%
PPV,% 96,5% 86%
NPV,% 100% 100%
Accuracy of MDCT in CABG Evaluation
Follow – up of Patients After Percutaneous Coronary Intervention
Types of artifacts related to stents
Stent type artifacts Stent strut thickness
Stent analysis
Total Stents Detectable Stents
Interpretable Lumen in Detectable Stents
Stent Location
LAD 64 58(91%) 15(55%)
LCx 63 32 (82%) 28 (44%)
RCA 75 52 (69%) 35 (47%)
SVG 6 6(100%) 6 (100%)
Stent diameter,mm
2,5 42 35 (83%) 12 (34%)
3,0 86 69 (80%) 40 (58%)
3,5 61 51 (84%) 41 (80%)
4,0 42 34 (81%) 28(82%)
4,5 1 1 (100%) 1 (100%)Gilard,M et al, Heart 2006,70
Comparison of the Different Reconstruction Protocols
RCA In - Stent Restenosis
LAD Stent
LAD Stent
LAD In - stent Restenosis
Diagnostic Accuracy of Multidetector CT to Detect In –stent Restenosis
All Patients Simple Stenting
ComplexBifurcation
stenting
Total, n 70 46 24
True negatives, n
55 39 16
True positives, n
10 6 4
Falsenegatives, n
0 0 0
False positives, n
5 1 4
Sensitivity, % 100(72-100) 100 (61-100) 100 (51-100)
Specificity, % 91 (82-96) 98 (87-99) 80 (58-92)
Accuracy, % 93 (84-97) 98 (89-99) 83 (64-93)
PPV, % 67 (42-85) 86 (49-97) 50 (22-78)
NPV, % 100 (93-100) 100 ( 91-100) 100 (81-100)Van MieghemCA,CademartiriiF, et al. Circulation 2006,114
MDCT may be an adequate modality for patients undergoing LM/LAD arteries intervention with stenting.
Stent in Bypass Conduits
CORE - 64Sensitivity 33,3 %
Specificity 91,7 %
PPV 57,1 %
NPV 80,5%
Accuracy 77,1 %
CONCLUSION. The results of our study showed that 64 –MDCT has poor ability to detect in – stent restenosis in small – diameter stents. Thus,64 – MDCT may be appropriate far stent assesment in only selected patients.
AJR:194, January 2010
National Cardiovascular Hospital
Thank you for attention