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

Kern, Morton J.

doi:10.1002/(sici)1097-0304(199811)45:3<307::aid-ccd19>3.0.co;2-q

Cited by 6 publications

(4 citation statements)

References 18 publications

(17 reference statements)

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“…It has been reported that patients with unligated LCA have developed exertional angina after CABG5–7 whereas appropriate ligation of IMA side branches has great importance to prevent the ‘steal phenomenon’ 5. The frequency of unligated side branches of IMA ranges between 9% and 25% verified by coronary angiography 5…”

Section: Discussionmentioning

confidence: 99%

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Exertional angina after cardiac bypass surgery successfully solved by endovascular occlusion of unligated lateral costal artery

Hudák,

Rašiová,

Moščovič

et al. 2023

BMJ Case Rep

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The internal mammary artery has become the primary conduit for the surgical revascularisation of the left anterior descending artery. Large side branches of internal mammary artery are typically ligated during cardiac surgery to avoid a potential coronary steal phenomenon. However, ligation of side branches can be unsuccessful due to the technically difficult surgical exploration of internal mammary artery branches. In this article, we present a case of a man who suffered from exertion angina pectoris despite successful surgical revascularisation of occluded left anterior descending artery by the internal mammary artery bypass. The coronary steal syndrome caused by the mighty side branch of internal mammary artery, that is, lateral costal artery was concluded as the reason of exertional angina. The endovascular procedure was performed and the lateral costal artery was successfully occluded using vascular plug. The occlusion of lateral costal artery has led to a complete disappearance of the exertional angina.

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Section: Discussionmentioning

confidence: 99%

“…Thus, the theory of CSP becomes doubtful. It is perhaps better to use the term diversion of systolic blood flow 5 8. Due to the unclear results of previous studies, several trials evaluating the haemodynamic consequences of unligated side branches of the IMA to coronary circulation and flow in an IMA have been carried out.…”

Section: Discussionmentioning

confidence: 99%

Exertional angina after cardiac bypass surgery successfully solved by endovascular occlusion of unligated lateral costal artery

Hudák,

Rašiová,

Moščovič

et al. 2023

BMJ Case Rep

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“…Ligation of the 1 st intercostal and more proximal branches of the LITA, which have superiority in left ventricular revascularization with 1A level of evidence, is of great importance to prevent "steal phenomenon". It's reported that non-ligated side branch frequency in coronary angiographies performed in patients who underwent coronary artery bypass grafting (CABG) is between 9-25% [4] .…”

Section: Introductionmentioning

confidence: 99%

Lateral Costal Artery: Clinical Importance of an Accessory Thoracic Artery

Vural¹,

Aglar²,

Şahin³

et al. 2018

Braz J Cardiovasc Surg

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The lateral costal artery has sometimes been identified as the culprit for the "steal phenomenon" after coronary artery bypass grafting, besides being occasionally used for myocardial revascularization. Its branches make anastomoses with the internal thoracic artery through lateral intercostal arteries. We aim to report, on three cases, the clinical significance of a well-developed lateral costal artery after coronary artery bypass grafting. Two out of three patients who underwent coronary artery bypass graft surgery in our center between June 2010 and August 2017, applied to us with stable angina pectoris, while the third one was diagnosed with acute coronary syndrome after applying to the emergency department. In coronary cineangiography, in all three cases, a well-developed accessory vessel arising from the proximal 2.5 cm segment of the left internal thoracic artery coursed as far as the 6th rib was detected, and it was confirmed to be the lateral costal artery. A stable angina pectoris in two of the patients was thought to be the result of steal phenomenon caused by the well-developed lateral costal artery. In the two cases with stable angina pectoris the lateral costal artery was obliterated via coil embolization. In the other case with the proximal left anterior descending artery stenosis, before percutaneous coronary intervention, the lateral costal artery was obliterated via coil embolization and the occluded subclavian artery was stented. Routine visualization in cineangiography and satisfactory surgical exploration of the left internal thoracic artery could be very helpful to identify any possible accessory branch of the left internal thoracic artery like the lateral costal artery.

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“…After surgery, a true steal phenomenon (reversed blood flow through a LIMA from a coronary artery) occurs only if the pressure is lower or proximal to the IMA origin 13 . If there is diversion of blood flow, it will be in systole since systemic arterial flow is predominantly systolic while the coronary circulation is mainly diastolic 14 . Even systolic flow diversion would have a trivial effect, since coronary systolic flow is minimal.…”

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confidence: 99%