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. 2022 Jan 24;23(3):299–314. doi: 10.1093/ehjci/jeab293

Figure 5.

Figure 5

CCTA in patients with previous CABG. (A and B) A 70-year-old man with previous CABG surgery (LIMA-LAD, SVG-OM1, SVG-OM2) and PCI + DES on RCA underwent CCTA for recent onset of atypical chest pain. An ECG-triggered axial acquisition (40–80% of the R-R interval) was performed by using a wide-detector CT scanner, covering a volume from the inferior margin of the heart to the top of the lung apices (A). The total DLP was 423.16 mGy*cm (B). (C and D) Venous graft to OM2: straight MPR (C) and volume rendering reconstruction (D) of the venous graft to OM2 showed sub-occlusion (arrow) of the distal anastomosis (OM2) whereas the graft conduit was patent. (E) LIMA graft: the LIMA graft to LAD and the distal anastomosis (distal LAD) were both patent as demonstrated by the volume rendering reconstruction. (F–I) Native coronary vessels: LM (F), LAD (F), and LCX (G) were diffusely calcified as shown in the corresponding straight MPRs. In addition, the curved MPR image of the RCA demonstrated a severe in-stent restenosis (H, arrow), which was confirmed by ICA (I, arrow). CABG, coronary artery bypass graft; CCTA, coronary computed tomography angiography; CT, computed tomography; DES, drug eluting stent; DLP, dose length product; ECG, electrocardiogram; ICA, invasive coronary angiography; LAD, left anterior descending artery; LIMA, left internal mammary artery; LM, left main; LCX, left circumflex artery; OM1, first obtuse marginal artery; OM2, second obtuse marginal artery; MPR, multiplanar reconstruction; PCI, percutaneous intervention; RCA, right coronary artery; SVG, single venous graft.