Optical coherence tomography findings after complicated coronary endarterectomy
Bibliographic record
Abstract
A 73-year-old male patient known to have hypertension and dyslipidaemia, underwent on pump coronary artery bypass grafting (CABG) with left internal mammary artery to left anterior descending artery, saphenous vein graft to first diagonal branch, first obtuse marginal and right coronary artery (RCA) with coronary endarterectomy to first diagonal and to RCA. Plaque was removed successfully from the length of the posterior descending artery (PDA); however, only partial removal was possible from the postero-lateral (PL) as the plaque segment detached from the distal vessel during the endarterectomy attempt. The patient developed inferior ST-elevation myocardial infarction (MI) 1 h after the operation. Urgent catheterization revealed patent grafts with some haziness at the distal segment of the RCA and a new stenosis in the PL branch that was not seen on pre-operative angiography. Optical coherence tomography (OCT) showed a normal vessel appearance in the distal PL (Panel A) followed by a stenosis with high backscattering, low attenuation, a very thickened intimal layer, and circumferential narrowing suggesting that the stenosis developed due to vessel recoil at the end of the endarterectomized segment (Panel B). The endarterectomized segment is visualized immediately proximal to the stenosis (Panel C) where the intimal and medial layers have been largely removed. A fibro-fatty lesion that was not removed at time of endarterectomy was present immediately distal to the anastomosis of the graft (Panel D). The anastomosis was widely patent and had a wide base that connected to PL and PDA both of which had undergone successful endarterectomy at these locations (Panel E, Asterisk represents PL). Dissection flap was visualized in the lumen of the main RCA representing residual vessel trauma from endarterectomy procedure (Panel F, white arrow). OCT imaging was crucial to elucidate the mechanism of periprocedural CABG MI and provided the residual vessel architecture post endarterectomy for the percutaneous coronary intervention planning. I would thank you Dr Matthew Sibbald, and Dr Natalia Pinilla for their helps making the manuscript. Consent: The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance. Conflict of interest: T.S. and G.D. are consultants for Abbott Vascular Inc. None of the other authors have conflicts of interest. Funding: None declared.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".