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LIMA-LAD Patency — EECC MCQ

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EasyCoronary Artery DiseaseLIMA-LAD PatencyEECC

A 58-year-old man with multivessel CAD undergoes CABG. The surgeon uses the LIMA as a pedicled graft to the LAD. What is the 10-year patency rate of the LIMA-LAD graft?

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Correct answer: B — >90% — the LIMA-LAD graft has the highest long-term patency of any coronary conduit due to the internal mammary artery's unique endothelial properties, resistance to atherosclerosis, and size-matching with the LAD

The LIMA-LAD graft is the cornerstone of CABG surgery with unmatched long-term patency: >90% at 10 years and ~85% at 20 years. The IMA's superiority results from: (1) endothelial function — IMAs produce higher levels of NO and prostacyclin than veins; (2) internal elastic lamina — provides a barrier to intimal hyperplasia; (3) size-matching with coronary arteries (2-3 mm diameter); (4) resistance to atherosclerosis. The 2024 ESC CCS Guidelines give the LIMA-LAD graft a Class I, LOE A recommendation. The survival benefit of CABG over PCI in left main and multivessel disease is largely attributed to the LIMA-LAD. A second arterial graft (radial artery or RIMA) to the second most important vessel provides additional benefit (Class IIa).

Reference: ESC (2024): CCS Guidelines; Loop et al. NEJM 1986