• Benny L Johansson, Domingos S R Souza, Lennart Bodin, Derek Filbey, Andrzej Loesch, Håkan Geijer, and Leif Bojö.
• Department of Cardiology, Örebro University Hospital, Örebro, Sweden. fabien.doguet@chu-rouen.fr
• Eur J Cardiothorac Surg. 2010 Oct 1; 38 (4): 414-9.

ObjectivesIn a long-term randomised coronary artery bypass grafting (CABG) study, the patency rate using a new 'no touch' (NT) vein-graft preparation technique was superior to the conventional (C) technique. This cineangiographic and intravascular ultrasound (IVUS) substudy examined possible mechanisms.MethodsA total of 45 patients (118 grafts) in the NT group and 46 patients (112 grafts) in the C group had patent grafts at short-term follow-up after 18 months. Thirty-seven patients (91 grafts) in the NT group and 37 patients (77 grafts) in the C group had patent grafts at long-term follow-up after 8.5 years, and were evaluated on a scale from 0 (normal) to 2 (significant stenosis) by cineangiogram. IVUS was performed in 15 NT grafts and 14 C grafts in the short-term follow-up, and 27 NT grafts and 26 C grafts in the long-term follow-up, in grafts considered normal by the cineangiogram. The grafts were evaluated with respect to lumen volume, intimal thickness, incidence of plaque and plaque components.ResultsIn the short-term follow-up, the cineangiogram showed more normal grafts (89.0% in the NT group compared with 75.0% in the C group), and the number of grafts with stenosis was 11.0% in the NT group compared with 25.0% in the C group (p=0.006). IVUS showed less mean intimal thickness (0.43 (0.07)mm vs 0.52 (0.08)mm; p=0.03), less grafts with considerable intimal hyperplasia (≥ 0.9 mm; 20% vs 78.6%; p=0.011) and fewer patients with considerable hyperplasia (≥ 0.9 mm; 25% vs 100%; p=0.007). In the long-term follow-up, the cineangiogram showed more normal grafts, with 91.2% in the NT group compared with 83.1% in the C group; there were fewer grafts with significant stenosis, with 7.7% in the NT group compared with 15.6% in the C group (p=0.14). IVUS showed fewer grafts containing multiple plaques (14.8% vs 50%; p=0.008), less advanced plaque with lipid (11.8% vs 63.9%; p=0.0004) and less maximal plaque thickness (1.04 (0.23)mm vs 1.32 (0.25)mm; p=0.02) in the NT group compared with the C group.ConclusionThe superior long-term patency rate using the NT vein-graft technique at CABG could be explained by a significantly slower progression of atherosclerosis.Copyright © 2010. Published by Elsevier B.V.

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