Coronary Arterial Bypass Lesions

  • Judit Karacsonyi
  • Mario Gössl
  • Daniel Lips
  • Michael Mooney
  • Imre Ungi
  • Subhash Banerjee
  • Emmanouil S. Brilakis
Chapter

Abstract

Arterial grafts include internal mammary, radial, and gastroepiploic artery grafts. Internal mammary artery grafts are the preferred conduit for coronary bypass graft surgery because of excellent long-term patency, whereas there is ongoing controversy on the role of radial artery grafts. Most internal mammary artery graft lesions occur at the distal anastomosis and can be treated with balloon angioplasty or implantation of a drug-eluting stent. Percutaneous coronary intervention of internal mammary grafts can be hindered by graft tortuosity, leading to target vessel ischemia upon wiring and difficult equipment delivery. Radial artery grafts are prone to spasm, especially early after implantation; hence, aggressive vasodilator administration is recommended before percutaneous coronary intervention to exclude spasm. Gastroepiploic grafts are infrequently used for coronary bypass graft surgery and may be difficulty to identify if bypass anatomy is not known at the time of angiography. If needed, arterial graft revascularization can be performed with high procedural success and low risk of complications.

Keywords

Arterial graft Percutaneous coronary intervention 

Notes

Disclosures

Dr. Rangan: Research grants from InfraReDx, Inc., and The Spectranetics Corporation.

Dr. Banerjee: Research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCARE Global (spouse); intellectual property in HygeiaTel.

Dr. Brilakis: Consulting/speaker honoraria from Abbott Vascular, Asahi, Cardinal Health, Elsevier, GE Healthcare, and St Jude Medical; research support from Boston Scientific and InfraRedx; spouse is employee of Medtronic.

The remaining authors have no conflicts of interest to disclose.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Judit Karacsonyi
    • 1
    • 2
  • Mario Gössl
    • 3
  • Daniel Lips
    • 3
  • Michael Mooney
    • 3
  • Imre Ungi
    • 2
  • Subhash Banerjee
    • 1
  • Emmanouil S. Brilakis
    • 1
    • 3
  1. 1.VA North Texas Health Care System and UT Southwestern Medical CenterDallasUSA
  2. 2.Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology CenterUniversity of SzegedSzegedHungary
  3. 3.Minneapolis Heart InstituteMinneapolisUSA

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