Microcoil embolization of large intercostal branches of internal mammary artery grafts

Abstract

Coronary artery steal via a large unligated intercoastal side-branch of the internal mammary artery graft has been previously described in two case reports. We report a series of 7 patients with post-operative angina in whom microcoil embolization of such branch was performed. In 5 patients in whom complete occlusion of the branch was achieved, anginal symptoms were relieved; in contrast the 2 patients with persistent flow through the intercostal branch remained symptomatic despite all their grafts being widely patent. We conclude that large unligated intercostal branches of the IMA graft may be related with post-operative angina and their embolization is a simple, safe, and effective procedure.

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

“…Although dobutamine echo was done preprocedurally in one study, it was not reported postprocedurally [4]. Angioplasty to other affected sites was sometimes combined with occlusion of side branches [3].…”

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Coronary steal due to unligated side branches of an internal mammary artery graft has been reported previously [1][2][3]. Embolization of these side branches has been shown to result in symptomatic improvement, but objective evidence of improved flow to the coronary artery has been lacking.

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Coronary steal by IMA bypass graft side-branches: A novel therapeutic use of a new detachable embolization coil

“…There are several reported cases of coronary steal attributed to the presence of large IMA side-branches in the literature [6][7][8][12][13][14][15][16][17][18][19][20][21][22][27][28][29][30]. Large IMA sidebranches have been noted to be present in up to 9% (41/459) of patients on preoperative angiography [23].…”

Novel technique for coil embolization of intercostal branch of internal mammary artery graft

“…Treatment of this clinical entity consists of elimination of the low-resistance vessel with surgery [4] or by transcatheter embolization [5][6][7][8][9]. The latter offers the advantages of a shortened hospitalization, the possibility of lower morbidity and mortality, and lower overall cost when compared to reoperation.…”