Spontaneous dissection of a left internal mammary artery bypass graft: images in cardiology.
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ABSTRACT:
SUBMITTER: Erkuner O
PROVIDER: S-EPMC8276319 | biostudies-literature | 2021 Jun
REPOSITORIES: biostudies-literature
Publications
Spontaneous dissection of a left internal mammary artery bypass graft: images in cardiology.
Erküner Ömer Ö Ahmed Wehab W Eerens Filip F
European heart journal. Case reports 20210626 6
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Project description: Not available
| S-EPMC8987330 | biostudies-literature
Project description:BackgroundInternal thoracic artery (ITA) grafts are commonly used for coronary artery bypass grafting, with dissection to the graft being a rare occurrence. Herein, we describe a case of spontaneous ITA graft dissection occurring 11 years after grafting, with no clear precipitating incidence.Case summaryThe patient was a 61-year-old man who presented with a 3-month history of chest pain and dyspnoea. Dissection of the left internal thoracic artery (LITA) graft was observed on angiography, with a thrombolysis in the myocardial infarction (TIMI) grade 2 blood flow. Intravascular ultrasound confirmed an intimal tear in the proximal graft, with an intramural haematoma. In the absence of atherosclerotic changes, the dissection was treated directly using multiple drug-eluting stents to prevent further extension of the intramural haematoma proximally into the subclavian artery and distally to the anastomosis site. Post-procedural angiography revealed an enlarged true lumen of the LITA, shrinking of the intramural haematoma, and improvement in blood flow to a TIMI grade 3. Chest symptoms resolved immediately after the procedure, with the patient remaining asymptomatic over the 6-month period following the procedure.DiscussionDissection of the ITA graft can occur spontaneously long after the initial grafting. Intravascular ultrasound is useful for diagnosis. Ensuring adequate coverage of the edges of the dissection with stenting could prevent further extension of the intramural haematoma.
| S-EPMC8922694 | biostudies-literature
Project description:BackgroundThis study aimed to evaluate the early and mid-term outcomes of a novel strategy of using the in-situ left internal mammary artery (LIMA) with the great saphenous vein graft (SVG) to bypass the left anterior descending artery (LAD) in coronary artery bypass grafting (CABG).MethodsA total of 979 patients took part in this retrospective observational study; 83 patients were propensity-score matched to the LIMA + SVG group and 83 to the LIMA - LAD group. Early mortality, postoperative complications, mid-term major adverse cardiovascular and cerebrovascular events (MACCE) were compared among the two matched groups after the procedure.ResultsNo significant differences in early mortality and postoperative complications rates were detected between the two matched groups. For mid-term outcomes, the incidence of MACCE was slightly higher in the LIMA + SVG group, but there was no significant statistical difference (14.9% vs. 12.8%, hazard ratio =1.20, 95% CI, 0.24 to 7.95; P=0.70) between the matched groups. Computed tomography coronary artery angiography (CTCA) images showed a LIMA + SVG composite graft patency rate of 94% (32/34) 25 months after the procedure.ConclusionsUsing the in situ LIMA with SVG to revascularize LAD was associated with comparable early and mid-term outcomes. These findings may provide an alternative emergency strategy when in situ LIMA cannot bypass LAD. Further study needs to be conducted to test longer-term outcomes.
| S-EPMC7711400 | biostudies-literature
Project description: Not available
| S-EPMC9579804 | biostudies-literature
Project description: Not available
| S-EPMC5368458 | biostudies-literature
Project description:BackgroundThe inter-arterial anomalous course of the left main coronary artery (LMCA) originating from the right coronary sinus of Valsalva is a rare, though potentially lethal pathology. Coronary artery bypass grafting is a potential surgical therapy with previously reported success, however, there is concern for the possibility of graft occlusion in the setting of competitive native vessel flow.Case summaryA 48-year-old gentleman presented to our facility with a non-ST elevation acute coronary syndrome. A malignant anomalous course of the LMCA was confirmed using invasive coronary angiography and computed tomography (CT). The patient underwent surgical revascularization of the left anterior descending artery with a left internal mammary artery (LIMA) graft, which was found to be atretic on follow-up CT. Seven years later the patient underwent repeat CT imaging, which confirmed recanalization of the previously atretic LIMA.DiscussionWe present the first documented case of a patient with spontaneous recanalization of an occluded LIMA following bypass surgery for an inter-arterial anomalous course of the LMCA. We postulate that the dynamic obstruction of the anomalous LMCA led to variable flow dependence on the bypass graft and subsequent atresia of the LIMA, due to the favourable native flow conditions in the absence of significant obstructive coronary disease. The exact mechanism of LIMA recanalization remains unclear, but in our case may have been partly mediated by a small increase in left main plaque.
| S-EPMC6439389 | biostudies-literature
Project description:Guide-catheter-induced ostial coronary artery dissection is a feared complication of percutaneous coronary intervention, but thankfully the incidence is low. We describe a case of catheter-induced ostial dissection of the left internal mammary artery (LIMA) with multiple radial jump grafts during percutaneous coronary intervention of radial graft bifurcation disease via the LIMA. The dissection led to loss of flow and profound haemodynamic compromise and cardiac arrest as the LIMA supplied the majority of the myocardium in this patient. Intravascular ultrasound was not immediately available, so an Export AP thrombus aspiration catheter (Medtronic) was used over the coronary wire in place to allow the injection of contrast while simultaneously pulling back on the catheter to delineate the extent of the dissection and guide accurate drug-eluting stent placement. The report is a cautionary tale to the reader to treat the LIMA with respect and think long and hard before considering any interventional procedure that uses the LIMA as a conduit.
| S-EPMC10782429 | biostudies-literature
Project description:ObjectivesTo assess whether instantaneous wave - free ratio (iFR) value is associated with left internal mammary artery (LIMA) graft failure at 12 months follow-up post coronary artery bypass graft (CABG).BackgroundData suggests bypass to a non-significant left anterior descending artery (LAD) lesion due to visual over-estimation may lead to LIMA graft failure. Implementing iFR may result in better arterial graft patency.MethodsIn iCABG (iFR guided CABG) study patients planned to undergo an isolated CABG procedure was prospectively enrolled and iFR was performed for LAD. Coronary computed tomography angiography was performed at 2 and 12 months follow-up. The primary endpoint of this study was to determine the rate of LIMA graft occlusion or hypoperfusion at 2 and 12-months follow-up. We considered a composite secondary endpoint of Major adverse cardiovascular and cerebrovascular event (MACCE) as a secondary outcome.ResultsIn total 69 patients were included with no differences regarding age, sex and risk factors. At 2 months, 50 of LIMAs with pre-CABG iFR median 0.855 (0.785 - 0.892) were patent. Hypoperfusion was found in 8 LIMAs (median iFR 0.88 (0.842 - 0.90)). While, 7 LIMAs (median iFR 0.91 (0.88 - 0.96)) were occluded (p = 0.04). At 12 months, when iFR of LAD was >0.85: just 12 (31.6% out of all patent LIMAS) grafts were patent and 24 (100.0% out of all hypoperfused/occluded) grafts were hypoperfused or occluded (p < 0.001). In terms of MACCE, no difference (p = 1.0) was found between all 3 groups divided according to iFR value.ConclusionsInstantaneous wave - free ratio value above 0.85 in LAD is a powerful tool predicting LIMA graft failure at 1-year follow up period.
| S-EPMC10466988 | biostudies-literature
Project description:BackgroundAvulsion of the left internal mammary artery (LIMA) graft near the anastomosis to the left anterior descending artery (LAD) artery post-coronary artery bypass grafting (CABG) is a rare but potentially catastrophic complication which can result in sudden ischaemia, haemodynamic compromise and life-threatening bleeding into the pericardium.Case summaryWe report a case of a spontaneous LIMA graft avulsion at the site of the anastomosis to the LAD artery, which occurred 4 weeks post-conventional CABG surgery and resulted in anterior myocardial infarction (MI), cardiac tamponade and cardiogenic shock. This life-threatening event was treated by deploying a covered stent in the LAD artery and by coiling the dehisced LIMA graft.DiscussionTo our knowledge, this is the first report of late LIMA graft avulsion that has been uniquely and successfully treated by percutaneous coronary intervention.
| S-EPMC8276599 | biostudies-literature
Project description:It is sometimes difficult to identify the culprit lesion and treatment strategy in patients with acute coronary syndrome who have complex coronary lesions and jeopardized left internal mammary artery graft. This report describes a heart team approach for a non-ST-segment elevation myocardial infarction case with complex coronary vasculature. A 73-year-old man presented to the emergency department with crescendo angina. He had a history of total aortic arch replacement with concomitant coronary artery bypass graft using left internal mammary artery. Emergent coronary angiography demonstrated severe stenosis at left main trunk bifurcation caused by calcified nodule. While the bypass graft to left anterior descending coronary artery was patent, the proximal segment of left subclavian artery was occluded. Following the prompt discussion with our heart team, we performed percutaneous coronary intervention in the first step for treating the left main stenosis using rotational atherectomy into the unprotected left circumflex artery. After clinical recovery, stress myocardial scintigraphy identified the presence of anteroseptal ischemia, which indicated coronary subclavian steal syndrome due to left subclavian artery occlusion. Contrast-enhanced CT visualized that the occlusion originated from the anastomosis, suggesting the potential procedural risk of endovascular treatment by dilatation. Our heart team discussed again and decided to undergo axillo-axillary artery bypass surgery. He was discharged 8 days after the surgery without any sequelae. This is the rare case report of non-ST-segment elevation myocardial infarction who had similar condition to coronary subclavian steal syndrome after total aortic arch replacement. This case highlights the importance of a collaborative approach of the heart team to identify the best therapeutic strategy in a patient with complex coronary vasculature.
| S-EPMC9242785 | biostudies-literature