Determination of Positivity of Computed Tomographic Angiography in Poorly Visualized Left Anterior Descending Artery on Conventional Angiography

Objective: To determine the positivity of CT angiography in visualization of poorly visualized left anterior descending artery (LAD) on conventional angiography for decision of its surgical revascularization. Study Design: Descriptive study. Place and Duration of Study: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad, from July 2014 to March 2015. Methodology: This study involved 55 patients who had non-graftable LAD on conventional coronary angiography (CCA). All patients underwent computed tomography angiography (CTA). Patients having graftable LAD on CTA then underwent coronary artery bypass grafting (CABG). Peroperatively, the characteristics of LAD such as diameter, calcification and graftability were also recorded. Results: The mean age of the patients was 52.76 +/- 8.52 years. There were 45 (81.8%) male and 10 (18.2%) female patients. Out of 55 patients, CTA revealed graftable LAD in 33 (60%) cases while LAD was non-graftable in 22 (40%) cases. Out of 33 patients having graftable LAD, 26 (78.79%) patients underwent CABG; whereas, remaining 7 (21.21%) patients had different reasons like other associated diseases and refusal from surgery. Among those who underwent surgery, LAD was graftable in all the patients (100%) peroperatively. Peroperatively 11 (42.3%) patients had mild calcification followed by severe calcification in 9 (34.6%) and moderate calcification in 6 (23.1%) cases. Fifteen (57.7%) patients had LAD caliber >1.5 mm while 11 (42.3%) patients had LAD caliber between 1.25 - 1.5 mm peroperatively. Conclusion: Positivity of the CT angiography for poorly visualized LAD on conventional angiography was 60% in the present study.