The value of coronary CT angiography to assess graftability of left anterior descending artery before coronary artery Bypass surgery

Abstract

Assessment of graftability of the LAD is an important factor for decision making, when the Left anterior descending artery (LAD) is totally occluded, Multidetector computed tomographic (CT) angiography might identify the flow distal to the total occlusion better than invasive coronary angiography. To identify the value of CT coronary angiography in the assessment of LAD graftability when it is questionable invasive coronary angiography. Our study is a retrospective single center study, we included 18 patients with multivessel disease who were discussed for Coronary Artery Bypass Surgery (CABG) in combined meeting (including cardiologists and cardiac surgeons), the LAD graftability was questionable and patients referred for coronary CT angiography. From the 18 patients. There were 12 patients with concordance between both modalities that the LAD was found not graftable and those patients deferred from CABG. Four of them 4/12 underwent coronary angioplasty and stenting for other vessels and 8/12 continue on medical treatment only. There were six 6/18 patients who showed discordance between both modalities as the CT reveled graftable LAD while the invasive coronary angiography did not show it; those patients underwent successful CABG with LIMA to LAD. One of the CABG patients has LM arising from right sinus of valsalva. CT angiography detects the ominous course of LM between the aorta and pulmonary artery. Coronary CT angiography is a very valuable tool to assess graftability of the left anterior descending artery before Coronary Artery Bypass Surgery.