Bilateral vs Single Internal Thoracic Artery Grafting for Left Main Coronary Artery Occlusion

Chronic competitive flow from a patent arterial or venous graft to the circumflex system does not impair the long-term patency of internal thoracic artery to left anterior descending grafts in patients with isolated predivisional left main disease: Long-term angiographic results of 2 different revascularization strategies

“…1 The surgical approach to IOSLM is still matter of debate: the use of a single ITA-LAD graft, of bilateral ITAs, or of a mixed ITA plus SV configuration have all been advocated. 3 In any case, surgical revascularization has been reported to achieve suboptimal results: Arima and colleagues 1 reported a disappointing 62.5% patency rate at 10 years in this subset of cases and in the recent SYNTAX-LE MANS study 2 >15% of implanted grafts failed at 15 months' follow-up. The reasons for the poor results of surgery are not entirely understood, but chronic competitive flow very likely plays a role.…”

“…1 From a surgical perspective, IOSLM is a complex scenario in which coronary artery bypass grafting (CABG) has been reported to achieve suboptimal results 1,2 and there is no general consensus on the most appropriate conduits configuration. 3 Our institutions have traditionally adopted 2 different solutions in this setting: bilateral internal thoracic artery (ITA) grafts at St Luc Bouge and ITA on the left anterior descending (LAD) artery and saphenous vein (SV) on the circumflex system at Catholic University. Both solutions expose the ITA to a high degree of competitive flow; therefore, this patient population offers the opportunity to evaluate the effect of flow competition from different types of concomitant grafts on long-term ITA angiographic status.…”

A Rare Bilateral Variation in the Branches of the Internal Thoracic Artery: A Case Report

“…The internal thoracic artery (ITA), also referred to as the internal mammary artery (IMA), arises from the antero-inferior branch of the first part of the subclavian artery [1,2]. As the largest artery in the thoracic wall, the ITA descends into the thorax region, coursing anterior to the pleura and separated from the posterior surface of the ribs by the transversus thoracis muscle [3,4]. Along its course, the ITA gives rise to branches that supply various structures, including the thymus, breast, mediastinum and sternum [3,5,6].…”