Lack of evidence for improvement in internal mammary graft flow by occlusion of side branch

Abhyankar, Atul; Mitchell, Alison; Bernstein, Lewis

doi:10.1002/(sici)1097-0304(199711)42:3<291::aid-ccd14>3.0.co;2-p

Cited by 16 publications

(9 citation statements)

References 7 publications

(7 reference statements)

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“…They also suggested that the relatively low flow in the LITA was related to the coronary vascular bed resistance of the infarcted myocardium. 8 In the present patient, preoperative embolization was carried out for a large proximal branch that was considered too difficult to ligate during operation, because the patient's already poor hemodynamics would have deteriorated if coronary steal had occurred in the early postoperative phase. However, the LITA itself became occluded, which was considered to have been caused by the embolic gel entering the LITA.…”

Section: Discussionmentioning

confidence: 96%

“…6,7 However, several investigators have reported that coronary flow was not affected by the side branches of the LITA. 8,9 Ivert et al performed an angiographic follow-up study of LITA grafts and found that patients were asymptomatic after 11 years in spite of unligated LITA side branches. 10 On the other hand, Abhyankar et al reported that there was no significant change in the LITA flow after balloon occlusion of a side branch and that a patient with postoperative coronary steal was improved after 1 month without branch embolization.…”

Section: Discussionmentioning

confidence: 99%

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Doppler Features of Occlusion of the Internal Thoracic Artery due to Preoperative Branch Embolization

et al. 1999

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he left internal thoracic artery (LITA) procedure is now generally accepted for grafts, having longterm patency in coronary artery bypass grafting (CABG). In particular, it is considered the most suitable graft for the left anterior descending coronary artery (LAD). 1 However, postoperative coronary steal due to unligated side branches of the LITA graft has been reported. [2][3][4][5] We performed selective transcatheter embolization of a large branch of the LITA preoperatively, and detected postembolization LITA occlusion based on changes of the Doppler wave form. In this paper, we discuss the validity of LITA branch embolization, as well as reviewing the relevant literature. Case ReportA 61-year-old male was referred to the surgical ward because of a diagnosis that surgery for angina pectoris was indicated. He had an old myocardial infarction and suffered from hypertension, hyperlipidemia, and diabetes mellitus as coronary risk factors. Preoperative coronary angiography (CAG) revealed significant stenosis of the LAD and segment 2 of the right coronary artery (RCA). On the left ventriculogram, global wall motion was severely hypokinetic and the ejection fraction (EF) was 26%. On preoperative angiography of the LITA, a large first intercostal branch was found at the proximal portion, which had a diameter bigger than that of the LITA itself. We considered that the Japanese Circulation Journal Vol.63, October 1999 patient's hemodynamics would deteriorate if the coronary steal phenomenon occurred postoperatively, because his cardiac function was already quite poor. Therefore, selective arterial embolization of the branch of the LITA with a micro coil and cyanoacrylate was carried out preoperatively (Fig 1). At 2 days after embolization, transthoracic pulsed Doppler echocardiography was performed using an Acuson Sequoia C256 machine equipped with a 6 MHz transducer. The Doppler wave form at the 2nd intercostal space of the grafted LITA, obtained by the transthoracic approach, showed a biphasic pattern with a higher systolic and a lower diastolic component. The diameter of the LITA was larger than before the procedure (Fig 2) and the Doppler peak flow velocity was increased above that before embolization.Jpn Circ J 1999; 63: 819 -821 (Received May 17, 1999; revised manuscript received June 28, 1999; accepted July 19, 1999) The Second Department of Surgery, Nihon University, School of Medicine, Tokyo, Japan Mailing address: Mitsumasa Hata, MD, 30-1 Ooyaguchi Kamimashi, Itabashi-ku, Tokyo 173-8610, Japan. T Doppler Features of Occlusion of the Internal Thoracic Artery due to Preoperative Branch EmbolizationMitsumasa Hata, MD; Motomi Shiono, MD; Yukihiko Orime, MD; Tomonori Yamamoto, MD; Shinya Yagi, MD; Shunichi Kimura, MD; Haruhiko Okumura, MD; Satoshi Kashiwazaki, MD; Shinsuke Choh, MD; Tetsuya Niino, MD; Hideo Kohno, MD; Nanao Negishi, MD; Yukiyasu Sezai, MD A 61-year-old male was referred to the surgical ward by cardiologists because of a diagnosis of unstable angina with 3-vessel disease. On preoperative lef...

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Doppler Features of Occlusion of the Internal Thoracic Artery due to Preoperative Branch Embolization

et al. 1999

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“…Advocates for occlusion of LIMA side branches in the setting of LAD ischemia indicate that anginal symptoms often improve and objective measures of LAD ischemia frequently resolve [12]. However, proponents argue that coronary flow measurements often fail to document impaired flow to the LAD even in the setting of large LIMA branches [13,9]. Regardless of the controversy, the ability to effectively and safely treat patients with objective evidence of LAD ischemia in the presence of a large LIMA side branch remains important.…”

Section: Discussionmentioning

confidence: 99%

Use of the Amplatzer Vascular Plug® for treatment of coronary steal

Weinberg

French

Shavelle

2008

International Journal of Cardiology

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“…Successful ligation of these side branches surgically or through catheter embolization has been documented in the literature to effectively relieve anginal symptoms through mainly subjective measures [ 5 , 6 ]. However, the hemodynamic significance of large thoracic side branches has been largely debated and is still controversial [ 7 ]. We report here a case of refractory angina in a patient with history of CABG surgery where we physiologically demonstrate coronary steal via a large unligated thoracic side branch by measuring coronary flow reserve before and after selective thoracic side branch balloon occlusion and successful treatment by coil embolization of the branch.…”

Section: Introductionmentioning

confidence: 99%

Physiologic Functional Evaluation of Left Internal Mammary Artery Graft to Left Anterior Descending Coronary Artery Steal due to Unligated First Thoracic Branch in a Case of Refractory Angina

Sawaya

Liberman

Devireddy

2016

Case Reports in Cardiology

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Unligated side branches of the left internal mammary artery (LIMA) have been described in the literature as a cause of coronary steal resulting in angina. Despite a number of studies reporting successful side branch embolization to relieve symptoms, this phenomenon remains controversial. Hemodynamic evidence of coronary steal using angiographic and intravascular Doppler techniques has been supported by some and rejected by others. In this case study using an intracoronary Doppler wire with adenosine, we demonstrate that a trial occlusion of the LIMA thoracic side branch with selective balloon inflation can confirm physiologic significant steal and whether coil embolization of the side branch is indicated.

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Lack of evidence for improvement in internal mammary graft flow by occlusion of side branch

Cited by 16 publications

References 7 publications

Doppler Features of Occlusion of the Internal Thoracic Artery due to Preoperative Branch Embolization

Doppler Features of Occlusion of the Internal Thoracic Artery due to Preoperative Branch Embolization

Use of the Amplatzer Vascular Plug® for treatment of coronary steal

Physiologic Functional Evaluation of Left Internal Mammary Artery Graft to Left Anterior Descending Coronary Artery Steal due to Unligated First Thoracic Branch in a Case of Refractory Angina

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