Évaluation non invasive des pontages coronariens par scanner multibarrettes

The purpose of this paper is to describe the computed tomography (CT) examination technique after coronary artery bypass surgery. Our experience is based on 172 ECG gated computed tomography examinations (Toshiba Aquilion 64™ CT scanner) of patients with coronary artery bypass grafts. A total of 422 grafts (2.45±0.76 per patient) and 491 anastomoses (2.85±0.96 per patient) have been evaluated: 65% were internal mammary grafts, 33% saphenous grafts and 2% other. The grafts were normal in 79%, occluded in 14%, and 7% had a significant stenosis or a graft disease. The distal anastomoses were normal in 67%, stenotic in 2% and not evaluable in 17%. Invasive coronary arteriography was performed in 38 patients (90 grafts, 100 anastomoses) in whom graft lesions were demonstrated by the CT scan. Diagnostic results from each of the two investigations were compared. The sensitivity and negative predictive value of graft assessment were 100%. However, for the distal anastomoses, the diagnostic value was lower but remained strong: sensitivity = 90.9% and negative predictive value = 94.7%. These results demonstrate CT scanner accuracy for the assessment of coronary artery bypass grafts. It is more effective in examining grafts than distal anastomoses. It can be used in routine clinical practice as a first-intention test for patients with suspected graft dysfunction.