Pathology of the Radial and Internal Thoracic Arteries Used as Coronary Artery Bypass Grafts

Kaufer, Eric; Factor, Stephen M.; Frame, Rosemary; Brodman, Richard

doi:10.1016/s0003-4975(96)01393-8

Cited by 92 publications

(91 citation statements)

References 18 publications

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“…35,36 Other disadvantages of the RA include a slightly higher degree of atherosclerosis as compared with the LITA and its increased chance of being subject to previous iatrogenic vascular trauma. 33,37 However, the inability to use the RA because of severe calcification or chronic dissection from prior cannulation is relatively rare, occurring in less than 2% of candidates for RA harvest 34 (see Table 1). …”

Section: Potential Disadvantages Of Radial Artery Usementioning

confidence: 99%

Should Radial Arteries Be Used Routinely for Coronary Artery Bypass Grafting?

et al. 2004

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Section: Potential Disadvantages Of Radial Artery Usementioning

confidence: 99%

Should Radial Arteries Be Used Routinely for Coronary Artery Bypass Grafting?

et al. 2004

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“…In particular, the atherosclerosisresistant internal thoracic arteries have been documented to show essentially no intimal hyperplasia during the first 5 decades of life [8]. However intimal hyperplasia and even atherosclerotic lesions, have been reported to occur in the internal thoracic arteries of older individuals [9][10][11][12][13]. The development of pre-atherosclerotic intimal hyperplasia in atherosclerosis-resistant arteries in older individuals offers the opportunity to assess for the association of classic risk factors for atherosclerosis with the development of intimal hyperplasia.…”

Section: Introductionmentioning

confidence: 99%

“…The development of pre-atherosclerotic intimal hyperplasia in atherosclerosis-resistant arteries in older individuals offers the opportunity to assess for the association of classic risk factors for atherosclerosis with the development of intimal hyperplasia. Previous studies along this line have yielded inconsistent results as to a relationship between intimal hyperplasia in the internal thoracic artery and traditional risk factors for atherosclerosis [9][10][11][12]. However, these studies have been limited by several factors including apparent relatively random sampling of the vessel, and the inclusion of other lesion types in the analysis, particularly fatty streaks and advanced atherosclerotic lesions.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for atherosclerosis and the development of preatherosclerotic intimal hyperplasia

Cizek

Bedri

Talusan

et al. 2007

Cardiovascular Pathology

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Summary-Intimal hyperplasia or thickening is considered to be the precursor lesion for atherosclerosis in humans; however the factors governing its formation are unclear. In the atherosclerosis-resistant internal thoracic artery, pre-atherosclerotic intimal hyperplasia routinely forms during adulthood after the 4th decade and is associated with at least two traditional risk factors for atherosclerosis: age and smoking.Background-Intimal hyperplasia, or thickening, is considered to be the precursor lesion for atherosclerosis in humans; however, the factors governing its formation are unclear. To gain insight into the etiology of pre-atherosclerotic intimal hyperplasia, traditional risk factors for atherosclerosis were correlated with the intimal hyperplasia in an atherosclerosis-resistant vessel, the internal thoracic artery.Methods-Paired internal thoracic arteries were obtained from 89 autopsies. Multivariate logistic regression and multiple regression models were used to examine the association of preatherosclerotic intimal hyperplasia with traditional risk factors for atherosclerosis: age, gender, hypertension, smoking, body mass index, diabetes, and hypercholesterolemia.Results-Atherosclerotic lesions consisting of fatty streaks and/or type III intermediate lesions were identified in 19 autopsies. Only age >75 years was found to be significantly correlated with atherosclerotic lesion development (P=0.01). Multiple regression model of the intima/media ratio in all 89 cases revealed age >75 years (P<0.0001), age 51-75years (P=0.0012), smoking (P=0.008) and hypertension (P=0.02) to be significantly correlated with intimal thickness. In the 70 cases without atherosclerosis, only age 51-75 years (P=0.006) and smoking (P=0.028) were found to be significantly associated with pre-atherosclerotic intimal thickening.Conclusions-In the atherosclerosis-resistant internal thoracic artery, pre-atherosclerotic intimal hyperplasia routinely forms during adulthood after the 4th decade and is associated with at least two traditional risk factors for atherosclerosis: age and smoking. These observations indicate that in some settings, intimal hyperplasia may be part of the disease process of atherosclerosis, and that its formation may be influenced by traditional risk factors for atherosclerosis.

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“…10 In addition, the radial artery has a much higher propensity for the development of atherosclerosis as compared with the internal mammary artery. 11 These factors, combined with our angiographic outcome data, indicate that the radial artery is simply not equivalent to the internal mammary artery.…”

Section: Responsementioning

confidence: 81%

Letters Regarding Article by Khot et al, “Radial Artery Bypass Grafts Have an Increased Occurrence of Angiographically Severe Stenosis and Occlusion Compared With Left Internal Mammary Arteries and Saphenous Vein Grafts”

Acar

Cook

2005

Circulation

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Since its first clinical use by Carpentier in 1971, 1 the radial artery (RA) has become one of the grafts of choice in coronary surgery. The article by Khot et al 2 claims that the patency of RA grafts is lower than that of internal mammary artery (IMA) as well as venous grafts. We believe that their methodology is flawed, primarily because the sample studied is composed almost exclusively of patients presenting with angina, ECG changes, or both. In most other published reports, only Ϸ20% of patients have recurrent angina at 5 years. Therefore, we believe that the denominator used to calculate the rates of patency is incorrect, and the results obtained by the authors may be misleading. Furthermore, it would appear that the RA was often used in high-occlusion-risk situations, which could account for the low observed patency rate in this highly selected population. For example, 22% of the patients underwent redo surgery, a substantially high proportion of patients in a daily practice, and a situation in which target vessels are often suboptimal. In one third of the cases, the RA was anastomosed to the right coronary artery, which is known to be at high risk for occlusion, whereas the number of right IMA grafts constructed in this area was so small that it did not allow a statistical comparison. Therefore, we believe that it is dangerous to extrapolate the patency data observed in this series to a homogeneous cohort of patients. These results are at variance with previously published series, which established that the patency of the RA graft was 92% and 83% at 1 and 5 years, respectively. These rates are comparable to those of the right IMA graft. Several studies have reported that use of the RA as opposed to vein grafts improved survival and decreased the incidence of cardiac-related events within the first postoperative years. 3,4 In our practice, this graft has been used on a routine basis since 1989. The low morbidity rate associated with RA harvesting led us to use this conduit rather than the right IMA to complement the left IMA-to-left anterior descending artery graft. 5 In conclusion, we believe that the message transmitted by the title of this article relies on a flawed methodology and that its conclusions are contradicted by recently published data. Christophe Acar, MD To the Editor:The recent article by Khot et al 1 raises serious concerns about patency when the radial artery is used as a graft in coronary artery bypass grafting (CABG). The results of their retrospective analysis suggest that in patients predominantly presenting with signs and symptoms of myocardial ischemia after CABG, radial artery grafts have lower patency rates than do left internal mammary artery and saphenous vein grafts (SVGs). These sensational results are not only contrary to those of other researchers 2,3 but also contradict the expected benefits of radial artery use.Saphenous veins used as aortocoronary conduits are apt to develop intimal hyperplasia, followed by atheromatous change. This characteristic has been proved hist...

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Pathology of the Radial and Internal Thoracic Arteries Used as Coronary Artery Bypass Grafts

Cited by 92 publications

References 18 publications

Should Radial Arteries Be Used Routinely for Coronary Artery Bypass Grafting?

Should Radial Arteries Be Used Routinely for Coronary Artery Bypass Grafting?

Risk factors for atherosclerosis and the development of preatherosclerotic intimal hyperplasia

Letters Regarding Article by Khot et al, “Radial Artery Bypass Grafts Have an Increased Occurrence of Angiographically Severe Stenosis and Occlusion Compared With Left Internal Mammary Arteries and Saphenous Vein Grafts”

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