Internal mammary artery graft dissection: a case-based retrospective study and brief review

The left internal mammary artery is the preferred graft for treating left anterior descending coronary artery disease. Dissection is a rare but grave sequela of internal mammary artery graft angiography. The available medical literature is scant, perhaps as a result of under-reporting. We report a case in which dissection of the internal mammary artery graft occurred during diagnostic angiography, and we discuss its management. In addition, we review the available literature and provide a retrospective analysis of the data from our own catheterization laboratory. In our single-center analysis of 542 cases of selective internal mammary artery graft angiography, we found only the single case of internal mammary artery graft dissection (0.2%) that we report here. Our review of the literature revealed 7 reported cases of internal mammary artery graft dissection, 3 of which were iatrogenic. There were no identifiable risk factors for such dissection. After treatment with angioplasty and stenting, all patients had good outcomes during follow-up.