Internal mammary angiography: a review of technical issues and newer methods

Up to 90% of coronary bypass operations in some centers now include at least one IMA graft. In parallel with the increased use of IMA grafts, our catheterization laboratory records for 1986-7-8 demonstrate a progressive increase in IMA angiography, both absolutely (11, 28, 48 cases/yr) and as a percent of restudy procedures performed after prior bypass (14, 25, 43%). Unfortunately, these records also show that cannulation of the right and left IMAs may involve substantial technical hurdles, resulting in a mean time of 19 +/- 19 min from catheter insertion to selective IMA angiography. Based on this experience, we review a standard technique for IMA angiography using preformed catheters, and describe alternative methods (including use of PTCA guidewires with or without super-selective catheters, and non-selective angiography utilizing a specially designed balloon occlusion catheter).