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Cardiac
Diagnosis
Coronary Artery Disease
Post-CABG Atherosclerosis
Post-CABG Atherosclerosis
Darragh Brady, MD; Gerard M. Healy, MD; Jonathan D. Dodd, MD, MSc, MRCPI, FFR(RCSI)
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Coronary artery bypass graft (CABG)

          • Definitions

            • Postoperative atherosclerotic disease of bypass grafts or native coronary arteries

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Echocardiographic Findings

                  • Angiographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    Selected References

                                    1. Erthal F et al: Cardiac computed tomography: Before and after cardiac surgery. J Thorac Imaging. 33(3):156-67, 2018
                                    2. Zhao Q et al: Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on saphenous vein graft patency 1 year after coronary artery bypass grafting: A randomized clinical trial. JAMA. 319(16):1677-86, 2018
                                    3. Patel MR et al: ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 69(17):2212-41, 2017
                                    4. Salata BM et al: Role of cardiac PET in clinical practice. Curr Treat Options Cardiovasc Med. 19(12):93, 2017
                                    5. Chan M et al: A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol. 221:898-905, 2016
                                    6. Authors/Task Force members. et al: 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 35(37):2541-619, 2014
                                    7. Mavrogeni S et al: Contribution of cardiovascular magnetic resonance in the evaluation of coronary arteries. World J Cardiol. 6(10):1060-6, 2014
                                    8. von Knobelsdorff-Brenkenhoff F et al: Cardiovascular magnetic resonance in adults with previous cardiovascular surgery. Eur Heart J Cardiovasc Imaging. 15(3):235-48, 2014
                                    9. Robertson KE et al: Prevention of coronary in-stent restenosis and vein graft failure: does vascular gene therapy have a role? Pharmacol Ther. 136(1):23-34, 2012
                                    10. Shukla N et al: Pathophysiology of saphenous vein graft failure: a brief overview of interventions. Curr Opin Pharmacol. 12(2):114-20, 2012
                                    11. Sun Z et al: Coronary CT angiography: current status and continuing challenges. Br J Radiol. 85(1013):495-510, 2012
                                    12. Şahinera L et al: Diagnostic accuracy of 16- versus 64-slice multidetector computed tomography angiography in the evaluation of coronary artery bypass grafts: a comparative study. Interact Cardiovasc Thorac Surg. 15(5):847-53, 2012
                                    13. Sørensen R et al: Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction. J Am Coll Cardiol. 57(10):1202-9, 2011
                                    14. Anders K et al: Coronary artery bypass graft (CABG) patency: assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography (MDCT) versus coronary angiography. Eur J Radiol. 57(3):336-44, 2006
                                    15. Pache G et al: Initial experience with 64-slice cardiac CT: non-invasive visualization of coronary artery bypass grafts. Eur Heart J. 27(8):976-80, 2006
                                    16. Chiurlia E et al: Follow-up of coronary artery bypass graft patency by multislice computed tomography. Am J Cardiol. 95(9):1094-7, 2005
                                    17. Frazier AA et al: Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings. Radiographics. 25(4):881-96, 2005
                                    18. Gasparovic H et al: Three dimensional computed tomographic imaging in planning the surgical approach for redo cardiac surgery after coronary revascularization. Eur J Cardiothorac Surg. 28(2):244-9, 2005
                                    19. Stauder NI et al: Assessment of minimally invasive direct coronary artery bypass grafting of the left internal thoracic artery by means of magnetic resonance imaging. J Thorac Cardiovasc Surg. 129(3):607-14, 2005
                                    20. Marano R et al: Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography. Eur Radiol. 14(8):1353-62, 2004
                                    21. Salm LP et al: Blood flow in coronary artery bypass vein grafts: volume versus velocity at cardiovascular MR imaging. Radiology. 232(3):915-20, 2004
                                    22. Willmann JK et al: Coronary artery bypass grafts: ECG-gated multi-detector row CT angiography--influence of image reconstruction interval on graft visibility. Radiology. 232(2):568-77, 2004
                                    23. Bunce NH et al: Coronary artery bypass graft patency: assessment with true ast imaging with steady-state precession versus gadolinium-enhanced MR angiography. Radiology. 227(2):440-6, 2003
                                    24. Langerak SE et al: Value of magnetic resonance imaging for the noninvasive detection of stenosis in coronary artery bypass grafts and recipient coronary arteries. Circulation. 107(11):1502-8, 2003
                                    25. Bedaux WL et al: Assessment of coronary artery bypass graft disease using cardiovascular magnetic resonance determination of flow reserve. J Am Coll Cardiol. 40(10):1848-55, 2002
                                    26. Hoogwerf BJ et al: A summary of the findings from the Post-CABG trial. Minerva Cardioangiol. 50(4):291-9, 2002
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Coronary artery bypass graft (CABG)

                                            • Definitions

                                              • Postoperative atherosclerotic disease of bypass grafts or native coronary arteries

                                            IMAGING

                                            • General Features

                                              • CT Findings

                                                • MR Findings

                                                  • Echocardiographic Findings

                                                    • Angiographic Findings

                                                      • Nuclear Medicine Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      Selected References

                                                                      1. Erthal F et al: Cardiac computed tomography: Before and after cardiac surgery. J Thorac Imaging. 33(3):156-67, 2018
                                                                      2. Zhao Q et al: Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on saphenous vein graft patency 1 year after coronary artery bypass grafting: A randomized clinical trial. JAMA. 319(16):1677-86, 2018
                                                                      3. Patel MR et al: ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 69(17):2212-41, 2017
                                                                      4. Salata BM et al: Role of cardiac PET in clinical practice. Curr Treat Options Cardiovasc Med. 19(12):93, 2017
                                                                      5. Chan M et al: A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol. 221:898-905, 2016
                                                                      6. Authors/Task Force members. et al: 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 35(37):2541-619, 2014
                                                                      7. Mavrogeni S et al: Contribution of cardiovascular magnetic resonance in the evaluation of coronary arteries. World J Cardiol. 6(10):1060-6, 2014
                                                                      8. von Knobelsdorff-Brenkenhoff F et al: Cardiovascular magnetic resonance in adults with previous cardiovascular surgery. Eur Heart J Cardiovasc Imaging. 15(3):235-48, 2014
                                                                      9. Robertson KE et al: Prevention of coronary in-stent restenosis and vein graft failure: does vascular gene therapy have a role? Pharmacol Ther. 136(1):23-34, 2012
                                                                      10. Shukla N et al: Pathophysiology of saphenous vein graft failure: a brief overview of interventions. Curr Opin Pharmacol. 12(2):114-20, 2012
                                                                      11. Sun Z et al: Coronary CT angiography: current status and continuing challenges. Br J Radiol. 85(1013):495-510, 2012
                                                                      12. Şahinera L et al: Diagnostic accuracy of 16- versus 64-slice multidetector computed tomography angiography in the evaluation of coronary artery bypass grafts: a comparative study. Interact Cardiovasc Thorac Surg. 15(5):847-53, 2012
                                                                      13. Sørensen R et al: Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction. J Am Coll Cardiol. 57(10):1202-9, 2011
                                                                      14. Anders K et al: Coronary artery bypass graft (CABG) patency: assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography (MDCT) versus coronary angiography. Eur J Radiol. 57(3):336-44, 2006
                                                                      15. Pache G et al: Initial experience with 64-slice cardiac CT: non-invasive visualization of coronary artery bypass grafts. Eur Heart J. 27(8):976-80, 2006
                                                                      16. Chiurlia E et al: Follow-up of coronary artery bypass graft patency by multislice computed tomography. Am J Cardiol. 95(9):1094-7, 2005
                                                                      17. Frazier AA et al: Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings. Radiographics. 25(4):881-96, 2005
                                                                      18. Gasparovic H et al: Three dimensional computed tomographic imaging in planning the surgical approach for redo cardiac surgery after coronary revascularization. Eur J Cardiothorac Surg. 28(2):244-9, 2005
                                                                      19. Stauder NI et al: Assessment of minimally invasive direct coronary artery bypass grafting of the left internal thoracic artery by means of magnetic resonance imaging. J Thorac Cardiovasc Surg. 129(3):607-14, 2005
                                                                      20. Marano R et al: Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography. Eur Radiol. 14(8):1353-62, 2004
                                                                      21. Salm LP et al: Blood flow in coronary artery bypass vein grafts: volume versus velocity at cardiovascular MR imaging. Radiology. 232(3):915-20, 2004
                                                                      22. Willmann JK et al: Coronary artery bypass grafts: ECG-gated multi-detector row CT angiography--influence of image reconstruction interval on graft visibility. Radiology. 232(2):568-77, 2004
                                                                      23. Bunce NH et al: Coronary artery bypass graft patency: assessment with true ast imaging with steady-state precession versus gadolinium-enhanced MR angiography. Radiology. 227(2):440-6, 2003
                                                                      24. Langerak SE et al: Value of magnetic resonance imaging for the noninvasive detection of stenosis in coronary artery bypass grafts and recipient coronary arteries. Circulation. 107(11):1502-8, 2003
                                                                      25. Bedaux WL et al: Assessment of coronary artery bypass graft disease using cardiovascular magnetic resonance determination of flow reserve. J Am Coll Cardiol. 40(10):1848-55, 2002
                                                                      26. Hoogwerf BJ et al: A summary of the findings from the Post-CABG trial. Minerva Cardioangiol. 50(4):291-9, 2002