Transcatheter embolization of an internal mammary artery bypass graft sidebranch causing coronary steal syndrome

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Interventions

Background:

• Internal mammary artery grafts are commonly used for coronary artery bypass grafting.
• Coronary artery steal syndrome can occur post-bypass, leading to myocardial ischemia.
• Diagnosis and management of rare complications are crucial for patient outcomes.

Observation:

• A 66-year-old male presented with angina symptoms following internal mammary artery-coronary artery bypass grafting.
• The patient's symptoms were attributed to coronary artery steal syndrome.
• A specific sidebranch of the internal mammary artery was identified as the source of the steal phenomenon.

Findings:

• Transcatheter embolization was performed to target the anomalous mammary artery sidebranch.
• The embolization procedure successfully occluded the sidebranch responsible for the coronary steal.
• Post-procedure, the patient's angina and myocardial ischemia resolved.

Implications:

• Transcatheter embolization offers a minimally invasive treatment option for coronary artery steal syndrome secondary to internal mammary artery anomalies.
• This case highlights the importance of considering vascular anomalies and steal phenomena in patients with refractory angina post-CABG.
• Successful embolization can prevent recurrent ischemia and improve patient outcomes in selected cases.