Intracoronary ultrasound-guided CABG in patients with angiographically noncritical lesions. Cardiovascular Surgery Associates.

BACKGROUND: Coronary angiography is used to determine the severity of coronary artery disease; however, in a small group of patients, clinically significant angina and physiologic tests indicative of myocardial ischemia do not correlate with angiographically demonstrable critical coronary artery disease. In these patients intracoronary ultrasound may demonstrate the true severity of lesions.
METHODS: Eight patients with angina and positive stress testing but without angiographically critical left main or left anterior descending artery stenoses were retrospectively identified. After intracoronary ultrasonic demonstration of critical left main or left anterior descending artery lesions, coronary artery bypass grafting was performed. Follow-up evaluation of clinical status and repeat stress testing were carried out.
RESULTS: Intracoronary ultrasound demonstrated critical left main (n = 4) or proximal left anterior descending artery (n = 7) stenoses in all patients. Severity of angiographic versus intracoronary ultrasound-documented stenoses was (mean +/- standard error of the mean) 10% +/- 10% versus 65% +/- 10% for left main lesions and 30% +/- 5% versus 75% +/- 5% for left anterior descending artery lesions. After coronary artery bypass grafting all patients had decreased angina and normalization of stress testing.
CONCLUSIONS: In patients with clinical presentations indicative of significant coronary artery disease but with angiographically noncritical lesions, intracoronary ultrasound can accurately assess the severity of stenoses. Coronary artery bypass grafting guided by intracoronary ultrasonic findings successfully treats myocardial ischemia in these patients.