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Incomplete revascularization post-coronary artery bypass grafting (CABG) may occur in up to one quarter of patients, and metaanalyses suggest this is associated with poor outcomes. ESC guidelines now prioritize complete revascularization when deciding between CABG or percutaneous coronary intervention (PCI). Adenosine stress perfusion cardiac magnetic resonance (MR) is well suited to determine the burden and location of ischaemia over and above scar, which may guide further revascularization after CABG. In our magnetic resonance experience, patients may receive bypass grafts that inadvertently leave proximal branches of the main coronary arteries trapped between a distal bypassed stenosis, and a proximal native stenosis.

european heart journal. case reports

The use of adenosine stress perfusion cardiac magnetic resonance in determining incomplete revascularization post-coronary artery bypass grafting and the importance of anterior septal vessels