Optical Coherence Tomography Imaging as a Quality Assurance Tool for Evaluating Endoscopic Harvest of the Radial Artery Nicholas S. Burris, BS, Emile.

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Presentation transcript:

Optical Coherence Tomography Imaging as a Quality Assurance Tool for Evaluating Endoscopic Harvest of the Radial Artery Nicholas S. Burris, BS, Emile N. Brown, BS, Michael Grant, BS, Zachary N. Kon, BA, Marc Gibber, MD, Junyen Gu, MD, PhD, Kimberly Schwartz, RNFA, MBA, Seeta Kallam, MD, Ashish Joshi, MD, MPH, Richard Vitali, PA, Robert S. Poston, MD The Annals of Thoracic Surgery Volume 85, Issue 4, Pages 1271-1277 (April 2008) DOI: 10.1016/j.athoracsur.2007.12.044 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Histologic confirmation of intimal injury was noted by the ex vivo optical coherence tomography (OCT) examination on (A) the luminal surface of the radial artery and (C) within the ostia of branch points exceeding 0.3 mm in diameter with thickened intima near the ostium. Image-guided biopsy specimens were obtained from areas suggested to be abnormal by OCT. As shown by these representative examples of (B) severe and (D) minor injury, registered histologic sections confirmed the diagnosis of intimal injury on every occasion and illustrate the near histologic resolution of OCT. (A: original magnification ×20, eosin stain; B: original magnification ×20, eosin stain.) The Annals of Thoracic Surgery 2008 85, 1271-1277DOI: (10.1016/j.athoracsur.2007.12.044) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraoperative evaluation of radial artery spasm using optical coherence tomography (OCT). Luminal diameter measurements obtained by OCT were compared for all radial arteries (RAs) at two time points: (A) in situ before harvest and (B) ex vivo after harvest. This representative example of a vessel from the endoscopic RA harvest group demonstrates a decline in the luminal area by 30% between the two measurements, suggesting spasm in response to intraoperative manipulation. The luminal volume of the RA was calculated between these time points using postprocessing software to maximize the sensitivity for detecting spasm. The Annals of Thoracic Surgery 2008 85, 1271-1277DOI: (10.1016/j.athoracsur.2007.12.044) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Postoperative evaluation of radial artery (RA) spasm using 64-multislice detector computed tomography. Two-dimensional planar image reconstructions were obtained parallel to the long axis of the RA to directly measure the diameters of the bypass grafts. These representative examples of RA grafts were imaged on postoperative day 5 after coronary artery bypass grafting. (A) Patient with a RA graft with an unaffected diameter. (B) Radial artery graft with “string sign.” The Annals of Thoracic Surgery 2008 85, 1271-1277DOI: (10.1016/j.athoracsur.2007.12.044) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions