Lesion Patterns and Graft Selection in Coronary Artery Bypass Graft for Radiation-Induced Coronary Disease

BACKGROUND Radiation triggers accelerated atherosclerosis, causing radiation-induced coronary artery disease (RICAD). When coronary artery bypass grafting (CABG) is indicated, conduit selection is challenging because internal mammary artery (IMA) patency may be compromised. Prior literature has largely focused on broad outcomes, with limited attention to lesion details and graft configuration. METHODS This retrospective study included consecutive patients with RICAD who underwent CABG between 1999 and 2025 across three Mayo Clinic centers. RICAD was defined as significant stenosis following therapeutic thoracic radiotherapy with a latency of > 5 years and with specific anatomical distribution. Descriptive statistics evaluated conduit utilization, survival, and need for circulatory support. RESULTS Sixty-nine patients underwent CABG (mean age 54.8 ± 10.7 years). Revascularization involved one vessel in 28 (40.6%) patients, two in 16 (23.2%), and three in 25 (36.2%). Although 60% were asymptomatic, severe stenosis was observed in major arteries (RCA, Left Main, and LAD). Ostial stenosis occurred in 26.1% of patients. LIMA was used in 85% of cases; in the remaining 15%, it was not used because it was deemed atretic, small-caliber, and fibrotic. Skeletonized techniques were used in 88.4%. Notably, no sternal complications occurred. 30-day mortality was 2.9%. Fourteen (20.3%) patients required subsequent reintervention, most commonly PCI. CONCLUSIONS CABG for RICAD was associated with high rates of complete revascularization and acceptable early postoperative outcomes in this cohort. Nevertheless, the unique anatomical distribution of the disease and the substantial need for subsequent reintervention underscore the importance of careful operative strategy and long-term monitoring.