Assessment of Radial Artery Graft Patency in Symptomatic Patients.

BACKGROUND: The purpose of this study is to evaluate the patency of radial artery (RA) grafts consistent with the target vessel characteristics. METHODS: Between October 2001 and January 2012, 83 symptomatic patients or patients with positive ischemic test results underwent coronary angiography following coronary artery bypass grafting. Of these, 68 patients with 81 RA grafts at a mean 49.2 ± 31.9 months (range, 1-137 months) were evaluated. According to the location and degree of proximal stenosis, 5-year graft patency was determined by Kaplan-Meier analysis. The relationships between RA graft patency and degree of proximal stenosis, target vessel location, and inflow characteristics of grafts were assessed by means of Cox proportional hazard models. RESULTS: Mean age of the patients was 56.4 ± 10.2 years. The period between the operation and postoperative coronary angiography was 49.2 ± 31.9 months (range, 1-137 months; median, 48.8 months). There was no impact on RA patency with regard to preoperative characteristics of the patients. RA patency was higher for left coronary system compared with right system (p = 0.038; 85.5 vs. 65.4%). In addition, patency rate was statistically higher for the proximal stenosis ≥ 90% (odds ratio, 3.65; 95% confidence interval, 1.20-11.07; p = 0.018). Kaplan-Meier patency analysis showed a patency of RA as 79.2% at 5 years. CONCLUSION: RA graft patency differs with degree of preoperative native coronary artery stenosis and location of target vessel. RA grafts to not severely stenosed (< 90%) coronary system and to the right coronary territory carry a remarkably high risk of graft failure.

Is female gender really a risk factor for carotid endarterectomy?

BACKGROUND: The aim of this study was to assess the effect of gender on mortality and morbidity in carotid endarterectomy (CEA) patients. METHODS: Forty-one female and 150 male patients who underwent isolated CEA operations, between 1994 and 2007, were included in this study. To find the role of gender in isolated CEA operations, patients with a previous history of cardiac operations, coronary interventions, and a staged cardiac and/or vascular operation were excluded from the study. RESULTS: In the postoperative period, one female patient (2.4%) and 8 male patients (4.9%) had neurological complications (p > 0.05). Hospital mortality rates of female and male groups were 0.0% and 2.4%, respectively (p > 0.05). Perioperative events which cause significant increase in hospital mortality were myocardial ischemia, low cardiac output, and need of intra-aortic balloon pump (p = 0.0001). Late mortality rates of female and male groups were 7.5% and 9.9%, respectively. The actuarial survival rate was 82.2 +/- 11.6% in women and 71.5 +/- 7.5% in men for a mean period of 36.4 +/- 29.1 months (p > 0.05). All the observed mortalities in the long term were cardiac-related or with other causes, no neurological deaths observed in both groups (p > 0.05). According to logistic regression analysis smoking and peripheral arterial disease were found as statistically significant risk factors for late mortality. CONCLUSION: Female gender is not a risk factor for stroke or death after CEA. Women should not be excluded from the benefits of CEA and gender should not be a consideration in the decision to perform it.

Chronic total occlusion of the left main coronary artery.

Total chronic occlusion of the left main coronary artery is a rare angiographic finding in a catheterization laboratory and its treatment rarely is reported. We describe a patient with angiographic findings of chronic total occlusion of the left main coronary artery with left coronary circulation collateralized from the right coronary artery.