Anomalous Origin of the Left Thyrocervical Trunk as a Cause of Residual Pain after Myocardial Revascularization with Internal Mammary Artery

Does a LIMA side branch ever need occlusion? (Why I don't think so)

“…As has been postulated in earlier case studies [8][9][10][11][12][13][14][15][16][17][18][19] (Table I), the Brooke Army Medical Center group also states that ''large side branches are capable of substantial run-off,'' which can compromise flow to the distal IMA, possibly due to relatively lower peripheral resistance as compared to higher coronary resistance [3]. This speculation on presumed physiology is not in concert with the measured coronary blood flow responses in the LIMA and its associated chest-wall branches [5][6][7].…”

“…With regard to clinical indications, the many single case examples previously reported [9][10][11][12][13]15,[17][18][19], both from surgical and radiologic experience with LIMA side-branch occlusion, raise three major issues: 1) that objective ischemia is variably present before the procedure, but all operators identify subjective ''ischemic complaints'' attributable to the ''preferential'' distribution of flow through the side branch away from the target coronary vessel based on angiography alone; 2) that the side-branch occlusion is variably successful over time; and 3) that subjective ischemia is always better, but the objective demonstration of whether side-branch occlusion relieved ischemia is often missing. Many reports use angiographic diameter of the LIMA and/or left anterior descending artery before and after side-branch occlusion as a surrogate for increasing blood, an erroneous supposition based on our experience of changing vessel tonus during angiography.…”

Microcoil embolization of large intercostal branches of internal mammary artery grafts

“…Early post-operative angina is usually due to a stenosis at the insertion anastomosis; other causes are subclavian artery stenosis [ 1,2], congenital anomalies of the brachiocephalic vessels [3], and, very rarely, coronary steal via large unligated intercostal or pericardial branches of the internal mammary artery [4]. This report describes 7 patients with post-operative angina who underwent microcoil embolization of a large unligated intercostal sidebranch of the internal mammary artery graft.…”

Abnormal origin of internal thoracic artery from the thyrocervical trunk: surgical considerations

“…The syndrome has been mentioned to originate from existent mammary side branches [41], proximal SCA stenosis [42] and ITA-TCT common trunk [43]. As a result, post-operative pain or even the need for re-operation may arise, as the implant may not be able to meet the myocardium oxygen demands [43]. The phenomenon co-exists with an unexpected blood flow inversion from the muscular regions that are normally supplied by the TCT branches.…”

“…It has been mentioned that in a patient underwent CABG intervention, the common origin of the ITA, inferior thyroid and suprascapular arteries, as it occurs in our case, is capable of causing pain and significant discomfort during shoulder movements. Manual exercise testing and angiographic results may prove the diagnosis postoperatively and vessels’ ligation could provide solution [43]. …”