Introduction
Coronary artery bypass grafting (CABG) remains the preferred
revascularization modality for the elective treatment of patients with
complex three vessel coronary artery disease. The left internal mammary
artery (LIMA) is routinely used for revascularization of the left
anterior descending artery. However, the choice of conduit used in
addition to the LIMA can be contentious. There is evidence that the use
of additional arterial grafts such as right internal mammary artery
(RIMA) and Radial Artery (RA); are associated with improved long-term
patency. LIMA grafting to the left anterior descending (LAD) artery and
use of a radial artery instead of the saphenous vein are Class I
recommendations in the 2018 ESC/EACTS guidelines on myocardial
revascularization. The use of bilateral IMA conduits is a Class IIa
recommendation. Stenosis of arterial grafts can occur in some patients
postoperatively. However, no reports have described an evaluation of
conduit using optical coherence tomography (OCT) to ascertain the
mechanism of stenosis. We describe the use of OCT in the evaluation of
suspected conduit stenosis in Total Arterial Revascularisation.