Читать книгу Interventional Cardiology - Группа авторов - Страница 265

CTA has been shown to be accurate in evaluating venous and arterial bypass grafts because they have a larger diameter and little calcification (Figure 10.1c–d). The challenge lies in evaluating the native coronaries, which are typically severely calcified in post‐CABG patients. Jungman et al. [33] reviewed 13 studies that assessed bypass grafts for stenosis of more than 50% and found that the sensitivity and specificity of CTA approached nearly 100%. This included two studies that used 265‐slice and 320‐slice CT, which were found to have similar accuracy to 64‐slice CT. The advantage of the newer scanners was the reduction in radiation dose. The study did reiterate though, that the sensitivity and specificity for evaluating native coronaries was lower. Currently, it is considered appropriate to use CTA for evaluation of graft patency in patients with ischemic symptoms [24]. Interestingly, a recent study showed that in patients with left main or triple‐vessel disease, the heart team management strategy based on CTA alone was in agreement with that made by ICA – suggesting that future decisions regarding revascularization strategy could possibly be based on CTA findings alone [34].