Modified dual guide catheter (“ping‐pong”) technique to treat left internal mammary artery graft perforation

Perforation of a left internal mammary artery (LIMA) graft during percutaneous coronary intervention is a rare event. We report a case of mid‐LIMA perforation treated by a polytetrafluoroethylene‐covered stent using a modification of the dual catheter (“ping pong”) technique. We propose that use of this modification when possible will further improve safety of treating a perforation. © 2014 Wiley Periodicals, Inc.     

Restoration of patency of left internal mammary artery graft with progression of the underlying left anterior descending coronary artery disease

The use of the left internal mammary artery (LIMA) to graft a borderline lesion in the left anterior descending coronary artery (LAD) has been associated with distal narrowing and occlusion of the LIMA. We present a patient in whom the LIMA occluded 1 year after coronary artery bypass, but was found to be fully patent 4 years later, after progression of the native LAD disease. Cathet. Cardiovasc. Diagn. 42:213–215, 1997. © 1997 Wiley-Liss, Inc.     

Laser angioplasty in a right coronary artery stent restenosis with the guidance of left internal mammary artery contrast injection: case report.

A 43-years-old male who underwent right coronary artery stent implantation 6 months ago presented with total occlusion of right coronary artery at proximal part of the stent without antegrade flow. We successfully used the left internal mammary artery contrast injections for guidance in all stages of the right coronary laser angioplasty intervention.     

Left internal mammary artery perforation during Swan-Ganz catheter insertion

A wide spectrum of complications is associated with invasive hemodynamic monitoring. We report an unusual case of perforation of the left internal mammary artery that occurred during percutaneous insertion of a Swan-Ganz catheter using the subclavian vein approach. To the best of our knowledge, this complication has not been previously reported. Cathet. Cardiovasc. Diagn. 44:317–319, 1998. © 1998 Wiley-Liss, Inc.     

Angiographic evaluation of a carotid-subclavian bypass graft in a patient with subclavian artery stenosis and left internal mammary artery bypass graft

The incidence of coronary subclavian steal syndrome is estimated to be 0.4%. When revascularization is necessary, the preferred technique is the carotid-subclavian bypass graft. Failure of a carotid-subclavian graft is rare. We present a patient with subclavian stenosis who required reevaluation of both the carotid subclavian conduit and the left internal mammary bypass graft. A combined femoral and left brachial approach is recommended for evaluating the carotid-subclavian graft and left internal mammary artery graft in patients with bypassed subclavian artery stenosis and prior myocardial revascularization. © 1994 Wiley-Liss,Inc..     

Stenting the distal anastomotic site of the left internal mammary artery graft: a case report

The major problem associated with the long-term patency of the internal mammary artery graft is the early occurrence of stenosis usually at its distal anastomotic site; its management by balloon angioplasty has been associated with a high success rate. We report the case of an unsuccessful balloon angioplasty of an anastomotic stenosis of a left internal mammary artery graft that was successfully managed by stenting with one-half of a Palmaz-Schatz stent. © 1994 Wiley-Liss,Inc..     

Endoluminal stenting of a subclavian artery stenosis to treat ischemia in the distribution of a patent left internal mammary graft

Subclavian artery stenosis is a rare cause of recurrent myocardial ischemia in patients who have undergone left internal mammary-coronary artery bypass grafting. A patient with this syndrome was successfully treated by placement of Palmaz biliary stents in the left subclavian artery. Angiographic and hemodynamic evidence of restricted subclavian flow resolved following stenting, as did the patient's unstable angina syndrome. Endoluminal stenting of the proximal subclavian artery for the treatment of coronary-subclavian steal can be performed safely and provides an alternative to other forms of surgical or percutaneous (PTCA, directional atherectomy) revascularization for treatment of this disorder. © Wiley-Liss, Inc.     

Balloon expandable stent implantation of a stenosis at the origin of the left internal mammary artery graft: A case report

We describe a case of percutaneous transluminal coronary angioplsty in which we implanted a balloon expandable Palmaz-Schatz stent into a high-grade restenosed lesion at the origin of the left internal mammary graft.     

Communication between a nongrafted left internal mammary artery and left anterior descending coronary artery following saphenous vein bypass grafting

A case is described in which a pericardial branch of a nongrafted left internal mammary artery communicated directly with the distal left arterior descending artery, following saphenous vein bypass grafting. This type of collateralization following coronary artery bypass surgery seems to be very rare, and perhaps could protect the myocardium from severe ischemia. Cathet. Cardiovasc. Diagn. 40:170–172, 1997. © 1997 Wiley-Liss, Inc.     

Combined PTCA and microcoil embolization of a left internal mammary artery graft

Internal mammary arteries are increasingly common conduits for coronary revascularization. Although infrequent, cardiologists are faced with a number of technical failures. We describe a case of combined PTCA to a LIMA insertion stenosis, along with coil embolization of a large unligated intercostal side branch. A complication of embolization is described along with angiographic follow-up.     

Intravascular stenting of the right internal mammary artery

Despite its tortuous course and small caliber, percutaneous transluminal coronary angioplasty of the internal mammary artery can be performed with a high initial success rate (82–94%). The successful deployment of a balloon expandable coll stent at the mid-right internal mammary artery in a patient with recurrent stenosis of that graft is reported.     

Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft

Objectives To evaluate the outcome of off-pump coronary artery bypass grafting (OPCABG) using a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization. Methods From October 2002 to December 2008, 208 patients (196 males and 12 females) underwent OPCABG using a BIMA Y configuration graft. The average age of the patients was 56.5 ± 11.3 years, with an age range of 33–78 years. A total of 167 (80.2%) cases had triple-vessel disease. Left main stem disease was found in 33 (15.9%) cases, and double-vessel disease was found in 8 (3.9%) cases. The semi-skeletonization technique was used to harvest the two internal mammary arteries (IMAs), and then the free right internal mammary artery was connected end-to-side to the left internal mammary artery (LIMA) in situ to complete the Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery in all patients. Graft patency was assessed intra-operatively with the HT311 transit time flowmeter. Results A total of 728 distal anastomoses were performed in 208 patients, with the average being 3.5 ± 1.3 per person. No one died or experienced recurrent angina within 30 days after the operation. Conclusions OPCABG using the BIMA Y graft was safe and effective to achieve total arterial revascularization. This method avoids surgical operation on the ascending aorta and other incisions.     

Crush stenting of bifurcational left subclavian-vertebral artery stenosis.

Left internal mammary artery (LIMA) has the best long-term patency in patients undergoing coronary artery bypass surgery. Stenosis of the proximal left subclavian artery (SA) may reduce flow to the LIMA, causing myocardial ischemia. We report a novel technique (crush stenting) for the treatment of a complex bifurcational left SA-vertebral artery (VA) stenosis in the presence of a patent LIMA bypass conduit. This technique limited plaque shifting, restored normal flow to all vessels, including the LIMA, and avoided devastating consequences of VA occlusion.     

Anomalous origin of left internal mammary artery from the lateral junction of the left subclavian artery and aorta

We describe the first reported case of an internal mammary artery originating from the junction of the left subclavian artery and aorta. Noting this, along with other reported anomalies and various pathologic conditions, it appears warranted to perform routine preoperative internal mammary artery angiography before coronary artery bypass surgery. © 1996 Wiley-Liss, Inc.     

Avoiding the left internal mammary artery during anterior pericardiocentesis

In patients with pericardial effusions who require anterior pericardiocentesis, it is important to avoid trauma to the left internal mammary artery. Such trauma could result in severe bleeding or tamponade. This article describes how the left internal mammary artery may be identified by duplex ultrasound, and therefore avoided. It is also important to ensure that the needle stick is just lateral to the artery, to avoid hitting the left lung.     

Part XIII: Role of large pectoralis branch artery in flow through a patent left internal mammary artery conduit

We report a case of perforation of an intermediate branch during attempted directional atherectomy of an ostial left anterior descending artery lesion, resulting from disruption of the cutter drive cable. Potential contributing factors and means of avoiding this complication are discussed. © 1995 Wiley-Liss, Inc.     

Outcomes of left internal mammary artery with saphenous vein composite graft to bypass the left anterior descending artery: a propensity-matched study

BackgroundThis study aimed to evaluate the early and mid-term outcomes of a novel strategy of using the in-situ left internal mammary artery (LIMA) with the great saphenous vein graft (SVG) to bypass the left anterior descending artery (LAD) in coronary artery bypass grafting (CABG).MethodsA total of 979 patients took part in this retrospective observational study; 83 patients were propensity-score matched to the LIMA + SVG group and 83 to the LIMA − LAD group. Early mortality, postoperative complications, mid-term major adverse cardiovascular and cerebrovascular events (MACCE) were compared among the two matched groups after the procedure.ResultsNo significant differences in early mortality and postoperative complications rates were detected between the two matched groups. For mid-term outcomes, the incidence of MACCE was slightly higher in the LIMA + SVG group, but there was no significant statistical difference (14.9% vs. 12.8%, hazard ratio =1.20, 95% CI, 0.24 to 7.95; P=0.70) between the matched groups. Computed tomography coronary artery angiography (CTCA) images showed a LIMA + SVG composite graft patency rate of 94% (32/34) 25 months after the procedure.ConclusionsUsing the in situ LIMA with SVG to revascularize LAD was associated with comparable early and mid-term outcomes. These findings may provide an alternative emergency strategy when in situ LIMA cannot bypass LAD. Further study needs to be conducted to test longer-term outcomes.     

Assessment of left internal mammary artery graft patency by transthoracic Doppler echocardiography

BACKGROUND: The successful application of noninvasive Doppler spectrum analysis has been reported for the hemodynamic assessment of LIMA graft after myocardial revascularization. HYPOTHESIS: The objective of this study was to assess the utility of transthoracic Doppler echocardiography (TTE) in providing information on LIMA flow in patients after coronary artery bypass graft surgery. METHODS: In all, 22 patients (aged 62 +/- 8 years) with LIMA graft to the left anterior descending (LAD) coronary artery who underwent coronary angiography were assessed using high-frequency (5 MHz) transthoracic Doppler echocardiography. They were compared with 25 patients with angina (control group A, aged 59 +/- 12 years), in whom an ungrafted LIMA was assessed, and with 17 patients (control group B, aged 59 +/- 9 years) with angiographically normal coronary arteries, in whom the LAD was assessed. RESULTS: A biphasic pattern (systolic and diastolic) was recorded in all cases. In 14 patients with a normal graft or < 70% stenosis (Group 1) and in control group B, blood flow was maximal during diastole. In eight patients with severe graft stenosis > 70% (Group 2) and control group B, blood flow was maximal during systole, with low diastolic flow. The diastolic fraction of the velocity time integrals was 0.81 +/- 0.11 for Group 1 and 0.25 +/-0.06 for Group 2 (p < 0.05). A diastolic velocity time integral fraction < 0.5 predicted > 70% stenosis with a sensitivity and specificity of 100%. The ratio of systolic/diastolic peak velocities was 0.61 +/- 0.31 for Group 1 and 3.21 +/- 0.49 for Group 2 (p < 0.05). A systolic/diastolic peak velocity > 1 predicted stenosis > 70% with a sensitivity and specificity of 100 and 90%, respectively. CONCLUSIONS: High-frequency TTE is a useful noninvasive method for detecting LIMA graft blood flow. Severe graft stenoses exhibited Doppler velocity patterns, which were different from those of patent grafts, or grafts with moderate stenoses.     

乳内动脉在冠状动脉旁路移植术中的应用

为了探索国人应用乳内动脉做冠状动脉旁路移植术的近期临床效果,从94年10月至98年3月共60例冠心病人采用乳内动脉、桡动脉及大隐静脉做冠状动脉旁路移植术(CABG).大多数为三支病变及左主干病变.中低温及常温体外循环,经主动脉根部间断灌注冷血或温血停跳液心肌保护.强调在取乳内动脉时要格外小心,不要用器械钳夹乳内动脉,牵拉应轻柔.采用8-0 Prolene线做乳内动脉与前降支等做远端吻合.吻合完成后应将乳内蒂固定于心脏表面,减少吻合口张力.最后切开左上心包让乳内动脉走行平坦,无张力.平均搭桥支数为3.5根.术后死亡1例,死亡率1.7%.使用乳内动脉做CABC是安全有效的.59例病人心绞痛完全缓解,活动能力及生活质量明显提高.     

Detection of patency of internal mammary artery grafts to the left anterior descending artery by transthoracic Doppler echocardiography

BACKGROUND: To determine whether a coronary artery bypass graft (CABG) is patent, we examined the flow of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) by transthoracic Doppler echocardiography (TTDE). PATIENTS AND METHODS: Eighty-seven patients with CABG (LIMA to distal LAD) were enrolled in the study. The flows from each subject were analyzed by three criteria: mosaic flow at the anastomosis site, distal anterograde flow (ante flow), and proximal retrograde flow (retro flow). RESULTS: On angiography, 79 grafts were patent and eight were not. TTDE study of 79 patent grafts demonstrated mosaic, ante, and retro flow in 63 (79.7%), 74 (93.7%), and 35 grafts (49.4%), respectively. The averaged diastolic peak velocity of ante flow was 26.3 +/- 11.0 cm/sec, significantly higher than that (4.8 +/- 7.1 cm/sec, P < or = 0.0001) in eight patients without patent grafts. These eight patients had no mosaic or retro flow and only three had ante flow. The accuracies to predict patency were 81.6%, 90.8%, and 49.4% for mosaic, ante, and retro flows, respectively. CONCLUSIONS: The existence of mosaic, retro, or sufficient ante flows strongly indicated the patency of LIMA to the LAD. When symptoms are possible to be derived from the occlusion of CABG to LAD, TTDE is a promising method to examine whether a LIMA to LAD bypass is patent.