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J Thorac Cardiovasc Surg 2005;130:1661-1667
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Late regression of left internal thoracic artery graft stenosis at the anastomotic site without intervention therapy

Chisato Izumi, MD a , * , Hidetaka Hayashi b , Yuichi Ueda, MD c , Masahiko Matsumoto, MD d , Yoshihiro Himura, MD a , Hiromitsu Gen, MD a , Takashi Konishi, MD a

a Departments of Cardiology,
b Radiology,
d Cardiovascular Surgery, Tenri Hospital, Nara, Japan
c Department of Thoracic Surgery, Nagoya University, Nagoya, Japan

Received for publication February 21, 2005; revisions received July 7, 2005; accepted for publication July 19, 2005.

* Address for reprints: Chisato Izumi, MD, Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri-city, Nara, 632, Japan (Email: izumi-ch{at}tenriyorozu-hp.or.jp).

OBJECTIVE: Intervention therapy has been recently performed on the left internal thoracic artery graft stenosis. The purpose of this study was to evaluate the natural course of the left internal thoracic artery graft stenosis at the anastomotic site and clarify whether intervention therapy should be performed early after surgery.

METHODS: We investigated early angiographic results of the left internal thoracic artery graft in 343 consecutive patients who underwent coronary bypass surgery. In 100 of 343 patients who underwent follow-up angiography, the graft diameter and percentage diameter stenosis at the anastomotic site were compared between early postoperative and follow-up angiography. None of these patients underwent intervention therapy on the left internal thoracic artery graft.

RESULTS: Of 343 patients, 46 showed 50% or greater diameter stenosis, and 20 showed 70% or greater diameter stenosis at the anastomotic site. In the 100 patients with follow-up angiography, the graft diameter significantly increased (1.8 ± 0.4 vs 2.1 ± 0.5 mm, P < .0001) at follow-up angiography. The percentage diameter stenosis significantly decreased (69% ± 13% vs 35% ± 20%, P < .0001) at follow-up angiography in the patients with 50% or greater diameter stenosis at early postoperative angiography. Regression of left internal thoracic artery graft stenosis was detected in most patients with 70% or greater diameter stenosis.

CONCLUSIONS: Our study demonstrated that left internal thoracic artery graft stenosis at the anastomotic site at early postoperative angiography might improve without intervention therapy. We should consider the natural course of the left internal thoracic artery graft stenosis in determining the indication of intervention therapy early after surgery.

Abbreviations and Acronyms LITA = left internal thoracic artery


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