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

Chalvatzoulis, Eleftherios; Ananiadou, Olga; Madesis, Athanasios; Christoforidis, Theofilos; Katsaridis, V.; Drossos, George

doi:10.1111/j.1540-8191.2011.01297.x

Cited by 4 publications

(4 citation statements)

References 12 publications

(13 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%

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%

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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“…Previous reports supporting the concept of IMA thoracic side branch steal and interventions to occlude the thoracic side branch have postulated improvement in myocardial ischemia through predominantly subjective measures of symptomatic angina relief or through a few reports of resolution of myocardial ischemia on stress testing [ 8 – 11 ].…”

Section: Discussionmentioning

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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“…The incidence of the large side branch of the in situ left ITA is reported to occur in approximately 10% of patients who have undergone coronary artery bypass grafting [ 3 ]. Some studies have demonstrated the existence of coronary steal due to a large left ITA (LITA) side branch in patients with recurrent angina [ 4 , 5 ]. It is hypothesized that a large ITA side branch has preferential flow and draws blood away from the myocardium through patent side branches, causing angina recurrence or graft failure.…”

Section: Discussionmentioning

confidence: 99%

Post-Coronary Artery Bypass Grafting Myocardial Ischemia Caused by an Overgrown Left Internal Thoracic Artery Side Branch

Kim

Kang

et al. 2014

Korean J Thorac Cardiovasc Surg

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We present a patient who developed recurrent angina after coronary artery bypass grafting (CABG). Myocardial single-photon emission computed tomography (SPECT) demonstrated deterioration in the myocardial perfusion, and coronary angiography revealed an overgrown side branch of the grafted left internal thoracic artery (ITA); otherwise, there were no significant changes compared with previous imaging studies obtained after the CABG. After percutaneous embolization of the grafted left ITA side branch, the angina was resolved and myocardial SPECT showed improved perfusion.

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

Cited by 4 publications

References 12 publications

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

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

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

Post-Coronary Artery Bypass Grafting Myocardial Ischemia Caused by an Overgrown Left Internal Thoracic Artery Side Branch

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