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Embolization of IMA side branch for post-CABG ischemia
1Illinois Masonic Medical Center, Chicago, USA. rhartzmd@aol.com
Insights
A chest wall "steal" phenomenon may cause recurrent angina after coronary artery bypass grafting. Embolizing a patent internal mammary artery branch resolved myocardial ischemia and angina symptoms.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Myocardial Ischemia Research
Background:
- Recurrent angina after coronary artery bypass grafting (CABG) is a clinical challenge.
- The "chest wall steal" phenomenon, where blood is diverted from the myocardium to the chest wall via patent internal mammary artery (IMA) grafts, is a debated cause.
- Physiological arguments against the steal phenomenon exist due to differing systolic and diastolic flow patterns in the chest wall and coronary arteries.
Abstract:
The existence of a chest wall "steal" of blood away from the myocardium through patent internal mammary artery branches has been hypothesized as a cause of recurrent angina pectoris after coronary artery bypass grafting. Although some authors believe that such a steal is physiologically impossible because coronary flow occurs in diastole and chest wall flow in systole, we recently documented ischemia in the left anterior descending coronary artery distribution before embolization of a large left internal mammary artery first intercostal branch that had been left intact at the time of operation. After embolization of the branch, clinical and objective evidence of ischemia resolved.
