Transbrachial coil occlusion of unligated thoracic side branch of arterial graft of internal mammary artery leading to silent ischemia in a diabetic patient

Left internal mammary artery side branch intervention in the management of coronary steal syndrome following coronary artery bypass grafting

“…In a subset of 17 patients with anterior wall ischemia who underwent side branch embolization, follow‐up stress imaging at 4.0 ± 1.0 months demonstrated significant improvement in the summed stress score and summed difference score (11.3 ± 3.0 vs. 6.5 ± 2.7, p < .001 and 6.1 ± 2.9 vs. 1.3 ± 1.2, p < .001, respectively). Numerous other case reports have described similar findings with resolution of anterior wall ischemia following side branch occlusion, supporting a causal mechanism by which occlusion of side branches may alleviate coronary steal 15–18 …”

“…Coil embolization has long‐since been a therapeutic modality for vessel occlusion and has been shown to have a high technical success rate in numerous conditions, including cerebral aneurysms, systemic‐pulmonary collaterals, and coronary fistulas 43–45 . A large number of case reports describe total resolution of angina following coil embolization to LIMA side branches, with a high technical success rate 3,17,18,20,23,24,26,29–33,39,42,46,47 . In a large case series, Sbarouni et al 2 performed coil embolization in seven patients who had presented with stable angina with large unligated side branches, which all spanned at least 5–7 intercostal spaces.…”

“…[43][44][45] A large number of case reports describe total resolution of angina following coil embolization to LIMA side branches, with a high technical success rate. 3,17,18,20,23,24,26,[29][30][31][32][33]39,42,46,47 In a large case series, Sbarouni et al 2 performed coil embolization in seven patients who had presented with stable angina with large unligated side branches, which all spanned at least 5-7 intercostal spaces. In five patients, complete occlusion of the branch was technically successful and resulted in total resolution of anginal symptoms.…”

Impaired Myocardial Perfusion from Persistent Mammary Side Branches: A Role for Functional Imaging and Embolization

“…The physiologic significance of these branches has also been questioned in the sense that many patients have these branches, but few have problems from them [4]. Nevertheless, there have been reports of clinical improvements following direct ligation [5] or coil embolization [6]. …”

Unligated Left Internal Mammary Artery Side Branch Resulting in Coronary Artery Steal Syndrome

“…Case reports have described chest pain on exertion with angiographic identification of the LIMA branch and resolution of symptoms after occlusion of the vessel 11 . Radionuclide imaging has shown ischemia in the LAD distribution distal to the LIMA anastomosis, with reversal to normal and corresponding relief of the patients symptoms 12 following coil embolization of the LIMA side branch. The issue of steal by unligated side branches of the LIMA is further complicated by the fact that large branches are often found without any clinical symptoms.…”