Samra Yasmin, Tahir Naveed, Abdul Wajid Khan Faisal, Shahid Hameed, Muhammad Ayub.
Role of computed tomography in visualization and assessment of graftability of totally occluded left anterior descending artery before coronary artery bypass grafting.
J Cardiovascular Dis Jan ;17(1):14-20.

BACKGROUND: Coronary artery disease (CAD) is one of the main cause of death worldwide. Chronic total occlusions (CTOs) are identified in up to one-third of patients referred for coronary angiography (CA) and its incidence increases with age. In some patients coronary angiography cannot visualize LAD artery after totally occluded segment. Computed tomography coronary angiography (CTCA) could identify the flow distal to total occlusion better than conventional coronary angiography so that LAD graftability can be established before planning coronary artery bypass grafting (CABG). AIMS & OBJECTIVE: To assess the graftability of LAD on CT angio before CABG MATERIAL & METHODS: This study was conducted in cardiovascular imaging department of P.I.C. Lahore over a period of 1 year, from 06-01-19 to 31-12-19. All patients with ACS regardless of age and gender were included who had occluded LAD on coronary angiography and distal LAD was not visualized. Patients with previous history of Ischemic heart disease, coronary artery bypass grafting, allergies to contrast medium and chronic kidney disease were excluded. Coronary angiography was done in 310 patients with acute coronary syndrome (ACS). These patients underwent CTCA to see LAD and its graftability as conventional coronary angiography could not visualize LAD artery distal to site of total occlusion. RESULTS: Total 310 patients with ACS were enrolled in the study where 257 patients were male (83%) and 53 patients were females (17%). Minimum age was 27 years and maximum age was 75 years, mean age was 51.25 + 5 years out of which in 303 patients (97.7%) LAD was visualized on CTCA and in 185 patients (81%) LAD was graftable, 156 (60.7%) were males and 29 (54.2%) were females. Regarding risk factors 110 (42%) male patients and 39 (73%) female patients had hypertension. 86 (33%) male patients and 24 (45%) female patients had diabetes mellitus. 105 (33.8%) males were smokers. 83 (32%) males and 19 (35%) females had family history of ischemic heart disease. 18 (7%) males and 3 (5%) females had hyperlipidemia. Minimum body mass index was 16.9 and maximum was 66.0 and mean body mass index was 27.48 + 5.2. With advances in computed tomography technique, computed tomography coronary angiography (CTCA) has become an established diagnostic method for detection of coronary arteries distal to occluded segment to plan for coronary artery bypass grafting (CABG). Hypertension is a major risk factor for coronary artery disease in both genders more so in females, while smoking is a major risk factor in male patients. CONCLUSION: CT coronary angio is a valuable diagnostic tool in visualization of totally occluded LAD. It has high diagnostic accuracy. Moreover it is also helpful in establishing the graftability of the vessel before CABG. Hypertension is a major risk factor in this subset of patients particularly in females while smoking is the major risk factor in males. KEY WORDS: Computed tomography, occluded left anterior descending artery visualization, coronary artery bypass grafting

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