INTRACORONARY ULTRASOUND-GUIDED CABG IN PATIENTS WITH ANGIOGRAPHICALLY NONCRITICAL LESIONS

Background. Coronary angiography is used to determine the severity of coronary artery disease; however, in a small group of patients, clinic ally significant angina and physiologic tests indicative of myocardial ischemia do not correlate with angiographically demonstrable critical coronary artery disease. In these patients intracoronary ultrasound m ay demonstrate the true severity of lesions. Methods. Eight patients w ith angina and positive stress testing but without angiographically cr itical left main or left anterior descending artery stenoses were retr ospectively identified. After intracoronary ultrasonic demonstration o f critical left main or left anterior descending artery lesions, coron ary artery bypass grafting was performed. Follow-up evaluation of clin ical status and repeat stress testing were carried out. Results. Intra coronary ultrasound demonstrated critical left main (n = 4) or proxima l left anterior descending artery (n = 7) stenoses in all patients. Se verity of angiographic versus intracoronary ultrasound-documented sten oses was (mean a 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 graft ing all patients had decreased angina and normalization of stress test ing. Conclusions. In patients with clinical presentations indicative o f significant coronary artery disease but with angiographically noncri tical lesions, intracoronary ultrasound can accurately assess the seve rity of stenoses. Coronary artery bypass grafting guided by intracoron ary ultrasonic findings successfully treats myocardial ischemia in the se patients. (C) 1997 by The Society of Thoracic Surgeons.