Catheter-based infrared light scanner as a tool to assess conduit quality in coronary artery bypass surgery Nicholas Burris, BS, Kimberly Schwartz, RNFA,

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Catheter-based infrared light scanner as a tool to assess conduit quality in coronary artery bypass surgery Nicholas Burris, BS, Kimberly Schwartz, RNFA, MBA, Cha-Min Tang, MD, PhD, M. Samir Jafri, PhD, Joseph Schmitt, PhD, Michael H. Kwon, BS, Ozeki Toshinaga, PhD, Junyan Gu, MD, PhD, Jamie Brown, MD, Emile Brown, BS, Richard Pierson, MD, Robert Poston, MD The Journal of Thoracic and Cardiovascular Surgery Volume 133, Issue 2, Pages 419-427 (February 2007) DOI: 10.1016/j.jtcvs.2006.09.056 Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Normal appearance of the radial artery and saphenous vein on optical coherence tomographic scans. A, Radial arteries demonstrate a 3-banded appearance by optical coherence tomography corresponding to a bright thin intima, a dark thick media, and a bright diffuse adventitia. The internal elastic lamina (IEL) of the radial arteries is well developed, as demonstrated by Verhoff van Giesen staining (elastin) of a healthy radial artery sample. B, Healthy saphenous veins demonstrate a 2-banded appearance by means of optical coherence tomography corresponding to the media (inner layer) and adventitia (external layer). The intima of normal saphenous veins is not resolved because the IEL is less developed than in radial arteries, as demonstrated by elastin staining, limiting the ability of optical coherence tomography to resolve intimal disruption in the saphenous vein graft conduit. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 419-427DOI: (10.1016/j.jtcvs.2006.09.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Optical coherence tomography provides real-time feedback on conduit injury in relation to harvesting technique. At least 1 intimal tear localized to the ostia of a branch point, such as that shown in this representative example, was observed in 88% of imaged segments obtained after endoscopic radial artery harvest. Overall, 21% of branches showed this injury after endoscopic radial artery harvest, whereas none of the branches were injured after open radial artery harvest. In addition, saphenous vein grafts harvested by using endoscopic techniques did not show this pattern of intimal injury at branch point ostia, as illustrated in the example. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 419-427DOI: (10.1016/j.jtcvs.2006.09.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Focal plaque in radial arteries and diffuse intimal hyperplasia in saphenous veins. A, Intimal thickening in radial arteries was most commonly observed to be eccentric and focal. This representative longitudinal reconstruction of the data obtained from an optical coherence tomographic examination demonstrates a discrete area of intimal thickening immediately adjacent to areas with normal intimal thickness. These eccentric intimal thickenings were defined as plaque. B, In contrast to the focal intimal thickening of the radial artery, intimal disease in the saphenous vein graft was manifested as concentric and diffuse thickening consistent with intimal hyperplasia. This representative longitudinal reconstruction shows this process is occurring on both sides of the vein and throughout the length of the imaged segment. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 419-427DOI: (10.1016/j.jtcvs.2006.09.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Clot strands observed in saphenous veins and radial arteries after endoscopic harvest. A, A luminal irregularity is observed on this representative optical coherence tomographic image that shows a characteristic shadowing artifact behind the strand. This shadowing is the result of erythrocytes within the clot strand that strongly attenuate the near-infrared light signal used by optical coherence tomography. B, Conduits with imaged clot strands were opened longitudinally to expose the luminal surface. The strand imaged by means of optical coherence tomography was confirmed to be a clot strand on the basis of gross examination of this representative segment. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 419-427DOI: (10.1016/j.jtcvs.2006.09.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Accurate identification and measurement of intimal hyperplasia in saphenous veins. A, Optical coherence tomography has the ability to accurately identify the intima and media in saphenous veins with intimal hyperplasia (intima is thick enough to be resolved by means of optical coherence tomography). The intimal/medial thickness ratio was determined by using optical coherence tomography. B, Optical coherence tomographic measurements of intimal/medial thickness ratio were compared with histologic measurements (gold standard). Optical coherence tomographic measurements were found to strongly correlate with histologic measurements on analysis with a Bland–Altman plot. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 419-427DOI: (10.1016/j.jtcvs.2006.09.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions