Microcoil embolization of large intercostal branches of internal mammary artery grafts

Coronary artery steal via a large unligated intercoastal side-branch of the internal mammary artery graft has been previously described in two case reports. We report a series of 7 patients with post-operative angina in whom microcoil embolization of such branch was performed. In 5 patients in whom complete occlusion of the branch was achieved, anginal symptoms were relieved; in contrast the 2 patients with persistent flow through the intercostal branch remained symptomatic despite all their grafts being widely patent. We conclude that large unligated intercostal branches of the IMA graft may be related with post-operative angina and their embolization is a simple, safe, and effective procedure.