We propose a change in perspective from risk to resilience toĭecipher mechanisms of atheroresistance and eventually identification of novel therapeutic targets presently not addressed Thereby elucidating its remarkable resistance to atherogenesis.
We aim here to provide insights into the anatomy, physiology, cellular, and molecular aspects of the internal mammary artery
Its endotheliumĪbundantly expresses nitric oxide synthase and shows accentuated nitric oxide release, while its vascular smooth muscleĬells exhibit reduced tissue factor expression, high tPA (tissue-type plasminogen activator) production and blunted migrationĪnd proliferation, which may collectively mitigate intimal thickening and ultimately the evolution of atheromatous plaques. Indeed, the internal mammary artery possesses unique biological properties that confer protection to intimal growthĪnd atherosclerotic plaque formation, thus making it a conduit of choice for coronary artery bypass grafting. Although all arterial bedsĮncounter a similar atherogenic milieu, the development of atheromatous lesions occurs discontinuously across the vascular Atherosclerosis is a systemicĭisease driven by a wide spectrum of factors, including cholesterol, pressure, and disturbed flow. Additionally, current smoking (OR: 2.67 95% CI: 2.60 to 2.74 p=0.01), reduced ejection fraction (OR: 1.76 95% CI: 1.04 to 2.97 p=0.04), severe stenosis (OR: 3.65 95% CI: 2.55 to 5.24 p=0.01), and diabetes mellitus (OR: 1.86 95% CI: 1.34 to 2.97 p=0.04) serve as the independent predictors for new native-vessel occlusion.Īs to high incidence of postoperative CTO, appropriate revascularization strategies and postoperative management should be taken into careful consideration.įueled by the global surge in aging, atherosclerotic cardiovascular disease reached pandemic dimensions puttingĪffected individuals at enhanced risk of myocardial infarction, stroke, and premature death.
The overall new occlusion rate was 35.59%, with multiple CTOs (42.06%) being the most prevalent (LAD 24.60% and RCA 18.25%, respectively). Therefore, the objective of the study is to determine predictors for new native-vessel occlusion in patients with prior coronary bypass surgery.ģ54 patients with prior CABG receiving follow-up angiography are selected and analyzed in the present study, with clinical and angiographic variables being analyzed by logistic regression to determine the predictors of new native-vessel occlusion. However, data available concerning the prevalence of new-onset CTO of native vessels in patients with prior CABG is limited. In conclusion, the decision to bypass or leave a native vessel with intermediate stenosis should cautiously be considered.Ĭhronic total occlusion (CTO) is prevalent in patients with prior coronary artery bypass grafting (CABG). Bypass graft was associated with new native-vessel disease progression regardless of baseline stenosis. By multivariate analysis, bypass grafting was associated with new native-vessel occlusion for non-LAD (odds ratio 3.04, 95% confidence interval 1.79 to 5.14 p <0.001). Furthermore, new occlusion rate of vessels with venous graft was the highest, followed by vessels with arterial graft and vessels without bypass graft, regardless of baseline stenosis (intermediate stenosis: 11.1% vs 5.2% vs 1.7%, p <0.001 severe stenosis: 23.7% vs 15.9% vs 9.9%, p <0.001). For non-LAD, new occlusion rate of vessels with bypass grafts was higher compared to those without bypass graft regardless of baseline native-vessel stenosis (intermediate stenosis: 8.6% vs 1.7%, p <0.001 severe stenosis: 20.5% vs 9.9%, p = 0.003). Over a mean follow-up period of 4.7 years, the new occlusion rates were 9.2% for left anterior descending artery (LAD), and 13.9% for non-LAD, respectively. We evaluated 911 patients with 2,271 nonoccluded vessels who underwent coronary artery bypass grafting and received follow-up coronary computed tomography angiography. We evaluated new native-vessel occlusion defined as occlusion length ≥15 mm as a surrogate marker of native-vessel progression. We sought to evaluate the impact of bypass grafting on native-vessel progression after coronary artery bypass grafting. Coronary computed tomography angiography is widely used to evaluate the graft patency, but information on the progression of native-vessel disease remains limited.