PTCA of the LAD via the internal thoracic artery graft with ultrasonic Doppler measurements for the evaluation of the result - a case report with literature review

The report presents a transluminal angioplasty (PTCA) of a severe stenosis of the left anterior descending artery (LAD) behind the anastomosis; the in ternal thoracic artery (ITA) graft was used as a conduit. Before and after the PTCA the changing of velocity flow patterns under rest and stress condi tions with a handgrip-maneuver were measured with a noninvasive transthorac ic ultrasound Doppler system. The mean diastolic velocity which represent c oronary perfusion through the ITA graft, increased after successful PTCA at rest and under stress conditions. An additional increasing of the mean dia stolic velocity at rest and under stress conditions was seen after six mont hs before the catheterization proposing no signs of restenosis. For this re ason the vessel could be classified prospectively patent. This could be con firmed during coronary angiography. We also present a review of the published reports concerning PTCA of ITA gr afts and PTCA of the native vessel using the ITA as a conduit. In this revi ew 286 cardiac interventions on 273 patients with a primary rate of success of 87% could be counted, the documented rate of restenosis was 30%, and th e rate of complication was approximately 1%. The PTCA in ITA grafts or of t he native vessel via ITA grafts, respectively, represent an alternative to reoperation. The ultrasound-duplex measurements are gaining an increasing significance f or the noninvasive patency rate and post-interventional monitoring of the l ong-term PTCA result. With the augmentation of the ITA as a coronary bypass and expected increase of postoperative; interventions, a noninvasive tool is necessary.