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Coronary Arterial Bypass Lesions

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Textbook of Catheter-Based Cardiovascular Interventions

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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.

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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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Authors and Affiliations

  1. VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, TX, USA

    Judit Karacsonyi MD, Subhash Banerjee MD & Emmanouil S. Brilakis MD, PhD

  2. Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary

    Judit Karacsonyi MD & Imre Ungi MD

  3. Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, MN, 55407, USA

    Mario Gössl MD, Daniel Lips MD, Michael Mooney MD & Emmanouil S. Brilakis MD, PhD

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  1. Judit Karacsonyi MD
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Correspondence to Emmanouil S. Brilakis MD, PhD .

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  1. Middle German Heart Center and Health Care Center Bitterfeld-Wolfen, gGmbH, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Karacsonyi, J. et al. (2018). Coronary Arterial Bypass Lesions. In: Lanzer, P. (eds) Textbook of Catheter-Based Cardiovascular Interventions. Springer, Cham. https://doi.org/10.1007/978-3-319-55994-0_51

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