Left internal mammary angiography complicated by subclavian tortuosity: a technical note

Current elective bypass procedures frequently involve placement of a left internal mammary artery (LIMA). Accordingly, there is an increased need to prove either preoperative adequacy or postoperative patency of this graft. We report a patient with a tortuous left subclavian artery inaccessible for any standard catheterization technique for LIMA opacification. The problem was overcome by a CHOICE PT guidewire whose trackability permitted the passage through the subclavian kinking and, subsequently, to coaxially advance a multipurpose catheter to the entrance of the LIMA. The described setting may be helpful for diagnostic LIMA imaging in selected cases.