Left Internal Mammary Artery Side Research Articles

A Novel Approach for Coronary Steal Syndrome Due to Left Internal Mammary Artery Side Branch

A Novel Approach for Coronary Steal Syndrome Due to Left Internal Mammary Artery Side Branch

Combined Cardiac PET-CT and Transcatheter Closure for Left Internal Mammary Artery Side Branch Steal Syndrome

We report on a patient with left internal mammary artery (LIMA) side branch steal syndrome and refractory angina who underwent successful transcatheter LIMA side branch closure after cardiac positron emission tomography−computed tomography assessment. The procedure resulted in improved myocardial ischemia, hyperemic blood flow, coronary flow reserve, and anginal symptoms. (Level of Difficulty: Advanced.)

Is stealing still a crime? Comment on left internal mammary artery side branch intervention in the management of coronary steal syndrome following coronary artery bypass grafting

Post-coronary artery bypass graft surgery (CABG) angina has been attributed unligated thoracic side branches competing with LIMA-LAD flow. Case reports suggest thoracic branch occlusion can relieve angina. Phasic arterial blood flow and direct measurements argue against the existence of LIMA steal.

Left internal mammary artery side branch intervention in the management of coronary steal syndrome following coronary artery bypass grafting.

The objective of this qualitative review is to summarize the pathophysiological and clinical data behind the clinical entity of left internal mammary artery (LIMA) side branch coronary steal as well as the potential diagnostic and therapeutic modalities available. The presence of persistent unligated LIMA side branches following coronary artery bypass grafting has previously been associated with stable angina and acute coronary syndromes. However, despite numerous attempts to objectively demonstrate a coronary steal phenomenon, the pathophysiology of LIMA side branch flow diversion remains elusive and the clinical utility of intervention is not well elucidated. A review of literature and available data including case reports, case series, and investigational studies was performed. Therapeutic closure of LIMA side branches has been reported in at least 44 patients and in at least 31 publications since 1990 and is associated with an 87.5% rate of freedom from angina amongst technically successful initial interventions. In all patients with pre- and post- stress testing, intervention was associated with an improvement and/or resolution of previously observed reversible ischemia. LIMA side branch coronary steal should remain an ongoing consideration in symptomatic patients with large unligated side branches on angiography, particularly when there is clear evidence of reversible ischemic on perfusion imaging.

Changes in sternal perfusion following internal mammary artery bypass surgery.

Coronary bypass surgery using the internal mammary artery (IMA) is among the most commonly performed procedures in treatment of advanced coronary vessel disease. Further, bilateral harvesting of the IMA is associated with increased rates of sternal wound infections. This study aimed to explore changes in sternal perfusion, following left internal mammary artery (LIMA) harvesting. 60 patients were divided equally into intervention- and control cohorts and underwent assessment of oxygen saturation (sO2) and relative blood flow (RBF) by laser doppler flowmetry remission spectroscopy preoperatively, 24 h and 72 h postoperatively. 24 h postoperatively a significant decrease of sO2 and RBF could be detected in LIMA harvest patients. After 72 h this difference disappeared. The side comparison within the groups 24 h postoperatively revealed a reduction of sO2 on the LIMA side within both groups. Regarding the 24 h RBF in side comparison, no significant differences could be detected within the groups. The 72 h side comparison showed an increased RBF for the non-LIMA side within the control group. The use of the LIMA may lead to significant decreases in local tissue oxygen saturation and RBF. This reduction is mostly distinct within the first 3 days postoperatively and may influence sternal wound infections.

Ischemia induced by coronary steal through a patent mammary artery side branch: A role for embolization

Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting.The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing.Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients.

Ischemia induced by coronary steal through a patent mammary artery side branch: A role for embolization

Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting.The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing.Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients.

The Unligated Left Internal Mammary Artery Side Branch as the Cause of Angina after Coronary Artery Bypass Grafting

The left internal mammary artery (LIMA) is a widely used conduit during coronary artery bypass graft (CABG) surgery because of its excellent long-term patency. Although large LIMA side branches are typically ligated during the surgery, the occurrence of a coronary steal phenomenon related to these side branches following surgery remains controversial. Advocates for occlusion of LIMA side branches in the setting of left anterior descending artery (LAD) ischemia indicate that anginal symptoms often improve and that objective measures of LAD ischemia frequently resolve. We present a patient with ischemia in the LAD distribution secondary to coronary steal from a large LIMA side branch that was successfully treated using the Embolization Coil-IMWCE-3-PDA5 (Cook Medical, Bjaeverskov, Denmark).

Unligated Left Internal Mammary Artery Side Branch Resulting in Coronary Artery Steal Syndrome

Whether internal mammary artery side branches have the potential for hemodynamically significant flow steal in cases of postcoronary surgery ischemia remains a controversial issue. We present a case in which coil embolization of two unligated side branches resulted in symptomatic improvement and resolution of ischemia as evidenced by myoview imaging.

Endovascular treatment in a patient with recurrent angina

The left internal mammary artery (IMA) is the preferred native graft for left anterior descending revascularisation owing to its favourable long-term patency and resistance to atherosclerosis. Incomplete ligation of the IMA side branches may cause recurrent angina due to flow diversion. Reoperation for ligating this unligated side branches may be performed but damage to the internal mammary artery or saphenous graft are the potential complications of this procedure. Therefore less invasive endovascular methods should be preferred. In this paper we report a patient with recurrent angina due to a large unligated left internal mammary artery side branch that was succesfully treated with percutaneous coil embolisation.