Postoperative radial artery angiography for coronary artery bypass surgery

Abstract

Objective: To compare radial artery (RA) patency with internal mammary artery (IMA) patency for coronary artery bypass surgery in our early experience. Methods: Symptomatic as well as asymptomatic patients with ≧1 RA coronary graft underwent postoperative angiography. Each anastomosis was considered separately. A string sign referred to a diffusely narrowed conduit, which did not fill the grafted coronary artery, as well as all occluded conduits. The raw value of P was adjusted for the testing of multiple hypotheses (P′). The patency data for each conduit was divided into two parts. ‘Cut-off’ stenosis for a conduit was the lowest dividing coronary stenosis at which a difference in patency rate with P≦0.05 occurred. Results: One-hundred-and-twenty-nine patients had 137 radial arteries and 157 angiograms. Only the most recent angiogram was analyzed for each patient at 13±0.7 months (n=129). Overall patency for arterial conduit 91% (n=404) was not different from venous conduit 91% (n=42) and patency for RA 90% (n=226) was not different from IMA 92% (n=178), (P′=0.999). Cut-off stenosis for RA was 70% and IMA was 40%. Patent arterial conduit had a mean coronary stenosis of 85% and non-patent conduit 64%, (P′≪0.001). Right coronary territory patency was 82 vs. 94% for other territories (P′=0.022). No overall differences in patency were noted for patients with sequential anastomoses, symptoms or coronary disease at the anastomosis at the time of surgery. Reversible ischaemia was detected in the distribution of only two of 14 string signs in patients undergoing sestamibi exercise protocol following angiogram. Conclusion : There were no differences in patency between radial artery and internal mammary artery at 13 months post-operative. Lower coronary stenosis and right coronary territory predicted lower patency. The clinical importance of a string sign remains to be determined.