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High-resolution 64-slice helical-computer-assisted-tomographical-angiography as a diagnostic tool before CABG surgery: the dawn of a new era?

^a Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
^b Department of Radiology, Hannover Medical School, Hannover, Germany
^c Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Braunschweig, Germany
^d Departments of Thoracic and Cardiovascular Surgery of the Participating Centers, Lower Saxony, Germany

Received 23 April 2007; received in revised form 3 July 2007; accepted 13 July 2007.

^_* Corresponding author. Tel.: +49 511 532 6588. (Email: simon.andre{at}mh-hannover.de).

Objective: For the first time, technical developments in helical, high-resolution 64-slice computer-assisted-tomographical-scanning (CT) allows for analysis of cardiac pathology including coronary morphology. Here, we present results of a multicenter study assessing the value CT-angiography as a preoperative diagnostic tool in identifying target vessels for coronary artery bypass grafting (CABG) surgery. Methods: Thirty-two patients aged 64 ± 9.0 years, 30 with confirmed coronary disease (angiography or scintigraphy) and 2 controls, underwent helical CT analysis. Scans were reviewed in a blinded fashion and potential target vessels for CABG were identified by seven individual reviewers. Results were compared with those from conventional coronary angiography and with the target vessels chosen at surgery. Results: Results showed a high positive predictive value for targeting at surgery, which was comparable for both conventional angiography and CT scan (LAD 100% vs 97%, RCx 96% vs 93%, 67% vs 56%). In one patient, who presented with clinical signs of CAD and positive scintigraphy results, conventional angiography revealed no stenotic lesion and CT scan was used to confirm main stem disease. Conclusions: CT-angiography sufficiently allows for target vessel determination for CABG. In individual cases, visual assessment of the left main coronary artery and the proximal left anterior descending artery (LAD) via CT-angiography may be superior to conventional angiography. However, while there is no difference in positive predictive targeting value, sensitivity and specificity of conventional angiography is still superior. Also, improvements in the methodology of evaluation and presentation of CT-findings are necessary. Our data suggest that CT-angiography may be used as a clinical alternative to conventional angiography in preoperative assessment for cardiac surgery.

Key Words: CT • Multi-slice • Coronary artery • Bypass graft • CABG