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Updated: Dec 8, 2025

Human Internal Mammary Artery IMA Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis
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Human Internal Mammary Artery IMA Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis

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Return of the Left Internal Mammary Artery

Nauman Khalid1, Evan Shlofmitz1, Yuefeng Chen1

  • 1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|September 21, 2020
PubMed

Insights

The string phenomenon describes left internal mammary artery (LIMA) narrowing. This study documents spontaneous recanalization of an atretic LIMA after coronary artery bypass grafting.

Area of Science:

  • Cardiovascular Surgery
  • Medical Imaging
  • Vascular Biology

Background:

  • The string phenomenon, characterized by left internal mammary artery (LIMA) narrowing or atresia due to competitive flow from native vessels, is a recognized clinical observation.
  • Understanding the natural history and potential for recovery of LIMA after coronary artery bypass grafting (CABG) is crucial for long-term patient outcomes.

Purpose of the Study:

  • To report the unprecedented spontaneous recanalization of a previously atretic left internal mammary artery (LIMA).
  • To investigate the implications of this phenomenon in patients undergoing coronary artery bypass grafting (CABG) for multivessel coronary artery disease.

Main Methods:

  • Case report detailing the clinical course and imaging findings of a patient with an atretic LIMA.
  • Review of relevant literature on the string phenomenon and LIMA behavior post-CABG.

Main Results:

  • The study observed spontaneous recanalization of an atretic LIMA in a patient who underwent CABG for multivessel coronary artery disease.
  • This recanalization occurred despite the initial diagnosis of LIMA atresia attributed to the string phenomenon.

Conclusions:

  • Spontaneous recanalization of an atretic LIMA is possible, challenging the notion of permanent vessel loss in the string phenomenon.
  • This finding may have implications for the assessment and management of LIMA grafts in patients with coronary artery disease.

Keywords:
AtresiaCoronary artery bypass graftingLeft internal mammary arterySpontaneous recanalization

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