Ischemia induced by coronary steal through a patent mammary artery side branch: a role for embolization

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Coronary artery bypass grafting (CABG) using internal mammary artery (IMA) grafts is standard practice.
• Non-occlusion of IMA side branches can lead to coronary steal, causing myocardial ischemia.
• Recurrent angina post-CABG necessitates investigation into graft patency and potential complications.

Observation:

• A 67-year-old male presented with recurrent angina and impaired anterior wall myocardial perfusion despite a patent left internal mammary artery (LIMA) graft.
• A patent LIMA side branch was identified as the cause of coronary steal phenomenon.
• Ischemia testing confirmed reduced myocardial perfusion due to abnormal flow diversion.

Findings:

• Percutaneous coil embolization of the patent LIMA side branch was performed.
• The intervention successfully improved coronary blood flow and resolved myocardial ischemia.
• Clinical symptoms of angina significantly improved post-procedure, confirmed by ischemia testing.

Implications:

• Coil embolization is an effective percutaneous treatment for coronary steal syndrome caused by patent IMA side branches.
• This intervention offers a viable option for carefully selected patients experiencing ischemia post-CABG.
• Management of IMA side branch patency is crucial for optimizing outcomes after myocardial revascularization.