Role Of Embolization Research Articles

Embolization for Pelvic Congestion Syndrome: A Mono-Centric Retrospective Study

Pelvic congestion syndrome (PCS) is a chronic condition characterized by chronic pelvic pain, often associated with pelvic varicose veins. Endovascular embolization has emerged as a minimally invasive treatment option for PCS, but there is limited data on its long-term efficacy and safety. In this retrospective study, we analyze the outcomes of embolization procedures performed for PCS at our institution over a specified period. Patient selection, procedural techniques, and clinical outcomes are evaluated, with a focus on pain relief, quality of life improvements, and incidence of complications. Our findings provide valuable insights into the role of embolization in the management of PCS and contribute to the existing literature on this topic.

Retrospective Analysis of Carotid Body Tumor Surgical Management: Roles of Preoperative Image Investigation and Preoperative Embolization

Carotid body tumors (CBT) surgery is a challenging procedure, and the role of embolization (EMB) in CBT surgery has remained unclear. This study is performed to analyze the management of CBTs, particularly the use of preoperative EMB and image features in minimizing surgical complications. A total of 200 CBTs were identified among 184 medical records involving CBT surgery. Regression analysis was used to explore the prognostic predictors of cranial nerve deficit (CND), including image features. In addition, blood loss, operation times, and complication rates were compared between patients who had surgery only versus patients who had surgery along with preoperative EMB. Overall, 96 males and 88 females were identified for inclusion in the study, with a median age of 37.0years. Computed tomography angiography (CTA) showed the presence of a tiny gap adjacent to the encasement of carotid vessels, which could help minimize carotid arterial injury. High-lying tumors that encased the cranial nerve were usually managed with synchronous cranial nerve resection. Regression analysis revealed that the incidence of CND was positively associated with Shamblin Ⅲ, high-lying, and a maximal CBT diameter of ≥ 5cm. Among 146 EMB cases, 2 cases of intracranial arterial EMB occurred. No statistical difference was found between the EBM and non-EBM groups in terms of bleeding volume, operation time, blood loss, blood transfusion requirement, stroke, and permanent CND. Subgroup analysis revealed that EMB decreased CND in Shamblin III and low-lying tumors. CBT surgery should be performed with preoperative CTA to identify favorable factors for minimizing surgical complications. Shamblin Ⅲ or high-lying tumors, as well as CBT diameter, are predictors of permanent CND. EBM does not reduce blood loss or shorten operation time.

Refractory periocular amblyogenic hemangiomas in childhood: Is there a role for embolization?

Objectives: The aim of the study was to evaluate the role of transarterial embolization (TAE) as a therapeutic modality for potentially amblyogenic periocular infantile hemangiomas (POIH) resistant to medical treatment. Material and Methods: We retrospectively analyzed the clinical, angiographic, and imaging data of four patients who underwent TAE as a pre-operative adjunct for POIH causing obstruction of the visual axis. Results: Rapid tumor shrinkage with early opening of the visual axis was achieved in all four POIHs. No complications occurred. The best results were achieved in non-congenital infantile hemangiomas and in the proliferative phase of the tumors. Conclusion: Our short series demonstrated that TAE may be a salvage treatment to unblock the visual axis before surgery or as a first-line definitive therapy for medically refractory and potentially amblyogenic POIHs.

Clinical course and role of embolization in patients with spontaneous rupture of hepatocellular carcinoma.

BackgroundA diverse clinical course after the spontaneous rupture of hepatocellular carcinoma (HCC) renders nonstandardized treatment protocols.PurposeTo evaluate clinical course and role of transcatheter arterial embolization (TAE) in patients with rupture of HCC.Materials and methodsThis retrospective study included 127 patients who were treated for ruptured HCC at single institution between 2005 and 2014. After multidisciplinary discussion, patients underwent medical management, TAE, emergency surgery or staged surgery. Patients were retrospectively divided into two groups based on the intent of treatment: curative and palliative. The rebleeding rate and 1-month and overall survival (OS) were compared between two groups. The incidence and survival of patients with intraperitoneal drop metastasis (IPDM) were also analyzed.ResultsThe overall rebleeding rate in patients who underwent TAE was 3.1% (3/96). One-month mortality rate was 6.3% (8/127). The rebleeding and 1-month mortality rates were not significantly different between two groups. OS was significantly higher in the curative treatment group (median: 12.0 vs 2.2 months, p<0.001). Among 96 patients who initially received TAE, ten patients underwent staged operation (10.4%). The median OS for medical management, TAE, emergency surgery and staged surgery was 2.8, 8.7, 19.1 and 71.1 months, respectively. Of all patients, 15.2% developed IPDM mostly within 1 year and their survival was poorer than that of patients without IPDM (median: 6.3 vs. 15.1 months, p<0.001).ConclusionTAE provided effective immediate hemostasis with a low rebleeding rate and may serve as a bridge to elective surgery. IPDM frequently occurred within 1 year and manifested poor survival; thus, close surveillance should be considered for patients with spontaneous rupture of HCC.

Hypercoagulation detected by routine and global laboratory hemostasis assays in patients with infective endocarditis

BackgroundCoagulation system is heavily involved into the process of infective endocarditis (IE) vegetation formation and can facilitate further embolization. In this study we aimed to assess the coagulation and platelet state in IE implementing a wide range of standard and global laboratory assays. We also aim to determine whether prothrombotic genetic polymorphisms play any role in embolization and mortality in IE patients.Methods37 patients with IE were enrolled into the study. Coagulation was assessed using standard coagulation assays (activated partial thromboplastin time (APTT), prothrombin, fibrinogen, D-dimer concentrations) and integral assays (thromboelastography (TEG) and thrombodynamics (TD)). Platelet functional activity was estimated by flow cytometry. Single nuclear polymorphisms of coagulation system genes were studied.ResultsFibrinogen concentration and fibrinogen-dependent parameters of TEG and TD were increased in patients indicating systemic inflammation. In majority of patients clot growth rate in thrombodynamics was significantly shifted towards hypercoagulation in consistency with D-dimers elevation. However, in some patients prothrombin, thromboelastography and thrombodynamics were shifted towards hypocoagulation. Resting platelets were characterized by glycoprotein IIb-IIIa activation and degranulation. In patients with fatal IE, we observed a significant decrease in fibrinogen and thrombodynamics. In patients with embolism, we observed a significant decrease in the TEG R parameter. No association of embolism or mortality with genetic polymorphisms was found in our cohort.ConclusionsOur findings suggest that coagulation in patients with infective endocarditis is characterized by general hypercoagulability and platelet pre-activation. Some patients, however, have hypocoagulant coagulation profile, which presumably can indicate progressing of hypercoagulation into consumption coagulopathy.

Intractable bleeding: the role of embolization in a resource-limited country

Transarterial catheter embolization is novel in Ghana, even though it has been practiced over three decades in certain parts of the world. The procedure is safer with the advent of new catheter techniques and embolic agents which place interventional radiology at the forefront of the treatment of bleeding due to myriad of indications. It is fast, safe, and minimally invasive relative to open surgery, especially when other conventional minimally invasive procedures such as endoscopic banding and sclerotherapy fail. This paper presents two cases involving pre-and post-embolization digital subtraction angiogram (DSA) of gastroduodenal artery and bilateral iliac arteries. Findings of DSA of the gastroduodenal artery and bilateral iliac arteries showed florid extravasation and extensive neovascularity. Post embolization DSA showed absent extravasation and near total devascularization. The inclusion of embolization to the management protocols of upper gastrointestinal bleeding and intractable haematuria is recommended

Assessment of the embolization effect of temperature-sensitive p(N-isopropylacrylamide-co-butyl methylacrylate) nanogels in the rabbit renal artery by CT perfusion and confirmed by macroscopic examination

Transcatheter embolization is an important treatment method in clinical therapy, and vascular embolization material plays a key role in embolization. The temperature-sensitive p(N-isopropylacrylamide-co-butyl methylacrylate) (PIB) nanogel is a novel embolic agent. To evaluate the feasibility of the nanogel as a blood vessel embolization agent, we aimed to assess the effect of embolization with PIB nanogels in the rabbit renal artery by non-invasive computed tomography (CT) perfusion, macroscopic and histological examination. Ten healthy adult Japanese rabbits were used to implement RAE of PIB nanogels in their right kidneys. CT perfusion scans were performed pre- and post-treatment at various time-points (1, 4, 8, and 12 weeks). Two rabbits were euthanized and histologically examined at each time-point, and the remaining rabbits were euthanized at 12 weeks after embolization. The RAE efficacy of the nanogels was further confirmed by macroscopic and histological examination. The renal volume and renal blood flow (BF) of the right kidney were significantly decreased post-treatment compared with those pre-treatment (volume: pre, 9278 ± 1736 mm3; post 1 week, 5155 ± 979 mm3, P < 0.0001; post 4 weeks, 3952 ± 846 mm3, P < 0.0001; post 8 weeks, 3226 ± 556 mm3, P < 0.0001; post 12 weeks, 2064 ± 507 mm3, P < 0.0001. BF: pre, 530.81 ± 51.50 ml/min/100 ml; post 1 week, 0 ml/min/100 ml, P < 0.0001; post 4 weeks, 0 ml/min/100 ml, P < 0.0001; post 8 weeks, 0 ml/min/100 ml, P < 0.0001; post 12 weeks, 0 ml/min/100 ml, P < 0.0001). No revascularization or collateral circulation was observed on histological examination during this period, and PIB nanogels were dispersed in all levels of the renal arteries. Twelve weeks after embolization, CT perfusion showed no BF in the right renal artery and renal tissue, a finding that was consistent with histological examination showing complete embolization of the right renal artery with a lack of formation of collateral vessels. The effect of embolization on PIB was adequate, with good dispersion and permanency, and could be evaluated by non-invasive and quantitative CT perfusion.

Small Intestine Artery False Aneurysm Embolization

Bleeding from an aneurysm of a small intestine artery is a formidable complication, the treatment remains a difficult problem. In this case, aneurysm embolization is indicated. The aim of the article is to describe the role of embolization in the treatment of bleeding in an elderly patient, to analyze the efficacy and risk. The advantage of the intervention is minimal invasiveness and low blood loss. The presented observation showed the effectiveness of endovascular embolization in the rupture of a pseudo-aneurysm.

Superior Rectal Artery Embolisation for Haemorrhoids: What Do We Know So Far?

Haemorrhoids are abnormally enlarged anal cushions within the lower rectum. They are common, and have potential to significantly impact patients' quality of life. Superior rectal artery embolisation is a technique which has been discussed in the literature as far back as 40years ago. More recently, there has been interest in the role of embolisation in the treatment for haemorrhoids, as an alternative to established minimally invasive and conventional surgical techniques. In this review, we discuss the current literature on the topic, with particular focus on technique, clinical outcomes and complications. Emerging procedural and technical considerations are discussed, with further review of the role of coil vs. particle embolisation.

Improvement of semen parameters after coil embolization of varicoceles: a systematic review.

This systematic review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including clinical studies in which one of the outcomes was semen parameter improvement after varicocele embolization using coils only. The objective of the review was to assess the evidence on the role of embolization using coils alone for semen parameter improvement in men with varicocele, since embolization using coils is the most cost-effective method of varicocele repair. Study quality was assessed using the methodological index for non-randomized studies (MINORS). Out of six retrospective and two prospective observational or comparative clinical studies involving 701 patients, semen concentration improved significantly in all five studies that assessed this parameter. Mean semen motility improved significantly in seven studies. The impact of embolization on semen density could not be analyzed.

Large parotid and cheek infantile hemangiomas refractory to medical treatment: Is there a role for embolization?

Objectives: The aim of this study was to evaluate the results of transarterial embolization (TAE) as a stand-alone treatment for large parotid and cheek infantile hemangiomas (IHs) that are refractory to medical treatment. Material and Methods: We retrospectively reviewed patients with head and neck IHs who underwent TAE at two single tertiary centers. We then analyzed the clinical and angiographic data of those patients with IHs located in the parotid and/or cheek regions. Results: A total of 38 patients with head and neck IHs were treated with TAE. Sixteen patients had a follow-up 2 months or more after treatment; from these patients, 6 IHs were located in the parotid or cheek regions. Four of the six tumors were in the proliferative phase. After TAE, almost 100% of angiographic obliteration of the IHs was attained. There was a complete shrinking of the tumor mass in all patients within a period of 2–5 months. One partially reversible complication occurred. Conclusion: Our preliminary results showed that TAE may be a useful therapeutic treatment not only before surgery but also as upfront and definitive therapy for parotid and cheek IHs.

The role of embolization before surgery for Spetzler-Ponce Class B and C brain AVMs: a prospective cohort series.

There is uncertainty of the benefit of preoperative embolization for Spetzler-Ponce Class (SPC) B and C arteriovenous malformations of the brain (bAVM). We examined whether or not preoperative embolization reduces the risk of permanent neurological deficits in SPC B and C bAVM surgery. A prospective bAVM database (between1989 and 2015) was analyzed by regression for factors associated with a new permanent neurological deficit arising as a consequence of surgery or preoperative embolization with a modified Rankin Scale (mRS) score >1 at 12 months after surgery (adverse outcome). From a cohort of 785 patients with bAVM, 277 patients with SPC B or C bAVM were planned for treatment by surgery with (N.=67) or without (N.=210) preoperative embolization. There were significant differences (embolization versus no embolization) in: permanent neurological deficits leading to a mRS>1 (45% versus 20%, P<0.01); permanent neurological deficits leading to a mRS>2 (22% versus 8.1%, P=0.04); perioperative transfusion of 2.5 liters of blood or more (31% versus 16%, P<0.01); and, delayed postoperative hemorrhage (19% versus 8.1%, P=0.01). Regression analysis identified the following factors to be associated with increased likelihood of an adverse outcome: infratentorial location (odds ratio 0.441, P=0.045); SPC C bAVM (OR=0.501, P=0.034); earlier rank order of surgery (OR=0.994, P<0.01); and, preoperative embolization (OR=0.313, P<0.01). The use of preoperative embolization does not reduce adverse outcomes in SPC B and C bAVM. The role of embolization in the preoperative management of complex bAVM by surgery deserves further study.

Juvenile Nasopharyngeal Angiofibroma: Our Experience in a Tertiary Hospital.

Nasopharyngeal angiofibroma is a highly vascular tumor seen typically in young adolescent males. It is an uncommon tumor accounting for less than 0.5% of all head and neck tumors. This peculiar tumor is thought to arise from the area of the sphenopalatine foramen and it classically presents with progressive nasal obstruction and epistaxis. This is a retrospective study of angiofibroma treated at our hospital over 3years. The study discusses about clinical features, management options and the role of embolization in reducing the intra-operative blood loss.

Ocular Arterial Occlusive Disorders and Carotid Artery Disease

To compare prevalence of carotid artery disease and its various types of lesions in different types of ocular arterial occlusive disorders. Cohort study. 614 consecutive patients (728 eyes) with ocular arterial occlusive disorders. At first visit, all patients had a detailed ophthalmic and medical history, comprehensive ophthalmic evaluation, and carotid artery evaluation (by Doppler/angiography) on the side of ocular arterial occlusion, and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit. Ocular arterial occlusive disorders were divided into central (CRAO) and branch (BRAO) retinal artery occlusion, ocular ischemic syndrome (OIS), non-arteritic anterior ischemic optic neuropathy (NA-AION) and amaurosis fugax (AF). Carotid artery and echocardiographic abnormalities, and incidence of transient ischemic attack (TIA)/stroke and myocardial ischemia. The study consists of a cohort of 266 eyes with NA-AION, 203 with CRAO, 127 with BRAO, 80 with OIS and 52 with AF. Carotid artery stenosis on the involved side was worse in AF and OIS compared to BRAO, CRAO, and NA-AION (p<0.0001). Presence of carotid artery plaques on the involved side was significantly higher in OIS, AF, and CRAO compared to NA-AION (p=0.002, p=0.003, and p=0.0003, respectively). Echocardiography revealed an embolic source in 61% of CRAO and 53% of BRAO compared to only 3% of NA-AION patients (p<0.0001). TIA/stroke before or after onset of ocular condition occurred in 17% of OIS, 11% of AF, 7% of CRAO, 6% of NA-AION, and 3% of BRAO patients. Kaplan-Meier estimate of the incidence of TIA /stroke within 3 months after onset was 6% (95% CI: 2%, 17%) for OIS, 3% (95% CI: 0.4%, 19%) for AF, and 1% (95% CI: 0.3%, 4.1%) for CRAO. Report of myocardial ischemia before or after onset of ocular condition was 52% in AF, 22% in OIS, 22% in BRAO, 21% in CRAO, and 6% in NA-AION patients. The incidence of carotid artery stenosis and plaques, cardiac embolic source, TIA/stroke and myocardial ischemia differ among various ocular arterial occlusive disorders. The role of embolism and hemodynamic disturbances caused by carotid artery disease in these disorders is discussed.

PWE-147 The Use of Angiography with A View to Embolisation In Non Variceal Gastrointestinal Haemorrhage Uncontrolled with Endoscopic Therapy, A 10 Year Experience at A Teaching Hospital

Introduction Gastrointestinal (GI) bleeding is a common medical emergency. The incidence is 1.33/1000 population, approximately 85,000 cases/year. The NCEPOD review of GI haemorrhage emphasised the role of embolisation in patients with GI bleeding who have failed endoscopic therapy. Transcatheter arterial embolisation (TAE) has been shown to be as effective as emergency surgery in the treatment of refractory acute non variceal upper GI bleeding (ANVGIB) with reduced 30 day mortality rates. The study aim was to review the utilisation and outcomes of patients undergoing emergency angiography (EA) with a view to embolisation in ANVGIB not amendable to, or controlled by, endoscopic therapy. Methods A retrospective analysis of patients undergoing EA for ANVGIB between January 2005 and February 2016 was performed. Patients were identified from endoscopy and radiology databases. Endoscopy reports and discharge letters were reviewed electronically. Successful embolisation was deemed when extravasation had stopped and/or no bleeding post embolisation. Results Over the study period, 22412 patients were diagnosed with GI bleeding. 57.9% (12967/22412) had an endoscopy. EA was performed in 107/12967 (0.83%) of patients undergoing endoscopy due to uncontrolled GI bleeding. Mean age was 69 years for males and 74 years for females (range 30–98); 74/107 were male. EA and embolization was performed in hours in 71% of cases and out of hours in 29%. Pre-angiography endoscopy report was available in 86/107 patients. The commonest endoscopic diagnosis was duodenal ulcer which was present in 25.6% (22/86) of the cases. A normal upper GI endoscopy was noted in 20.9% (18/86) of patients. Lower GI bleeding was the cause in 17.4% (15/86) of patients. Other causes included; unidentified bleeding point, dieulafoy lesion, gastric ulcer. Of those patients undergoing angiography 54/106 (50.9%) had TAE. TAE was deemed successful in 90.7% (49/54) of cases. Surgical intervention was necessary in 2/5 of the unsuccessful cases. The 30 day mortality for the patients undergoing angiography with or without intervention was 18/107 (16.8%). 57% (61/107) were alive at 1 year. Conclusion The results demonstrate that angiography and embolisation is a valuable tool in the management of GI bleeding not controlled by endoscopic therapy with a high success rate avoiding the need for surgery in the majority of cases. Our figures are comparable to published studies. The results support the need for 24/7 access to interventional radiology which is part of the recommendations from the NCEPOD review of the care received by patients who had a severe gastrointestinal haemorrhage. Disclosure of Interest None Declared

The Vulnerability of Vessels Involved in the Role of Embolism and Hypoperfusion in the Mechanisms of Ischemic Cerebrovascular Diseases.

Accurate definition and better understanding of the mechanisms of stroke are crucial as this will guide the effective care and therapy. In this paper, we review the previous basic and clinical researches on the causes or mechanisms of ischemic cerebrovascular diseases (ICVD) and interpret the correlation between embolism and hypoperfusion based on vascular stenosis and arterial intimal lesions. It was suggested that if there is no embolus (dynamic or in situ emboli), there might be no cerebral infarction. Three kinds of different clinical outcomes of TIA were theoretically interpreted based on its mechanisms. We suppose that there is a correlation between embolism and hypoperfusion, and which mechanisms (hypoperfusion or hypoperfusion induced microemboli) playing the dominant role in each type of ICVD depends on the unique background of arterial intimal lesions (the vulnerability of vessels). That is to say, the vulnerability of vessels is involved in the role of embolism and hypoperfusion in the mechanisms of ischemic cerebrovascular diseases. This inference might enrich and provide better understandings for the underlying etiologies of ischemic cerebrovascular events.

The role of embolization in reducing the complications of cryoablation in renal cell carcinoma

To investigate whether embolization prior to cryoablation would decrease morbidity without negative effects on tissue pathology, renal function, or recurrence. The electronic medical records of all patients undergoing cryoablation for renal cell carcinomas were reviewed for lesion size, pre-ablative renal function, post-ablative renal function, post-ablative complications, recurrence, and quality of biopsy specimen. Comparisons were made between patients who underwent cryoablation (the Cryo-Only group) and those who underwent cryoablation after same-day coil embolization of their lesion (the Cryo-Embo group). Further comparison was made between the Cryo-Embo lesions and the subset of larger Cryo-Only lesions (≥ 3 cm), which were expected to have a higher natural complication rate. A total of 21 lesions in 19 patients were treated by percutaneous cryoablation (17 Cryo-Only, four Cryo-Embo). Complications were seen in 83% of the large Cryo-Only lesions (average size 3.6 cm), whereas no complication was seen amongst Cryo-Embo lesions (average size 4 cm). Embolization significantly decreased complications between size-matched lesions (p = 0.048) without impacting renal function (p = 1), biopsy quality (p = 1), or recurrence (p = 1). Performance of trans-arterial embolization prior to cryoablation of large renal cell carcinomas significantly decreases complications, such as haemorrhage, without a discernible effect on biopsy quality, renal function, or recurrence rate.

Oncologic Outcomes Following Surgical Resection of Renal Cell Carcinoma with Inferior Vena Caval Thrombus Extending Above the Hepatic Veins: A Contemporary Multicenter Cohort

Suprahepatic inferior vena caval tumor thrombus in renal cell carcinoma cases has historically portended a poor prognosis. With advances in perioperative treatment of patients with high level thrombus contemporary outcomes are hypothesized to be improved. We evaluated long-term oncologic outcomes of contemporary surgical treatment of patients with renal cell carcinoma in whom level III-IV inferior vena caval thrombus was managed at high volume centers. We examined clinical and pathological data on patients with renal cell carcinoma and level III-IV thrombus treated with surgery from January 2000 to June 2013 at 4 tertiary referral centers. Survival outcomes and associated prognostic variables were assessed by Kaplan-Meier and multivariate Cox regression analyses. We identified 166 patients, including 69 with level III and 97 with level IV thrombus. Median postoperative followup was 27.8 months. Patients with no evidence of nodal or distant metastasis (pN0/X, M0) had 5-year 49.0% cancer specific survival and 42.2% overall survival. There was no difference in survival based on tumor thrombus level or pathological tumor stage. Variables associated with an increased risk of death from kidney cancer on multivariate analysis were regional nodal metastases (HR 3.94, p <0.0001), systemic metastases (HR 2.39, p= 0.01), tumor grade 4 (HR 2.25, p = 0.02), histological tissue necrosis (HR 3.11, p = 0.004) and increased preoperative serum alkaline phosphatase (HR 2.30, p = 0.006). Contemporary surgical management achieves almost 50% 5-year survival in patients without metastasis who have renal cell carcinoma thrombus above the hepatic veins. Factors associated with increased mortality included nodal/distant metastases, advanced grade, histological necrosis and increased preoperative serum alkaline phosphatase. These findings support anaggressive surgical approach to the treatment of patients with renal cell carcinoma who have advanced tumor thrombus.

Role of Embolization in the Treatment of Renal Masses

Renal arterial embolization (RAE) performed for the treatment of renal masses has been proven to be a safe and effective technique, with several decades of experience. RAE is well tolerated with few complications, particularly if the time interval from embolization to surgery is reduced to less than 48 hours. Review of the literature suggests that RAE is also extremely effective for palliation of symptoms in the setting of nonoperative advanced stage renal cell carcinoma. In addition, this technique plays a large role in the management of angiomyolipomas that are symptomatic or at risk of spontaneous rupture. To date, RAE has not been evaluated in a randomized controlled setting, which has contributed to its underutilization. All of these potential benefits warrant the need for prospective studies for further validation.

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.