Neoangiogenesis connecting a left internal mammary artery proximal stump to an ischemic area of the heart after bypass occlusion

Abstract

Internal mammary arteries (IMAs), via angiogenesis/arteriogenesis, have great potential for developing collaterals. This generally occurs when ischemia involves the inferior limbs or heart. Although this phenomenon may be spontaneous, it seems to be promoted by iatrogenic or voluntary occlusion of the IMAs. We present a patient who underwent triple coronary artery bypass grafting with two saphenous vein grafts and a free-graft left IMA and suffered an acute myocardial infarction 6 weeks after surgery. Emergency coronary angiography revealed occlusion of the grafts and an amazing branch arising from the proximal stump of the surgically-cut and clipped IMA, leading to the anterior wall of the heart, functionally creating an effective natural bypass, probably stimulated both by anterior wall ischemia and interrupted flow within the proximal left IMA. K E Y W O R D S angiogenesis, coronary artery bypass grafting, internal mammary artery, occlusion, refractory angina

Refractory angina pectoris: a 20-year (2003–2022) bibliometric analysis

“…Meanwhile, angiogenic growth factors are applied to the internal mammary artery to enhance the development of new collateral branches, thereby promoting improved blood flow to the heart ( 54 ). Researches had shown that internal mammary artery occlusion can increase the blood supply of extracardiac ipsilateral coronary arteries, leading to reduced ischemia in dependent myocardial regions and alleviating angina symptoms in patients ( 55 , 56 ). Although internal mammary artery occlusion has not yet gained widespread recognition as a standard treatment method and requires further evidence-based research, it is considered a novel approach for refractory angina or a potential alternative to coronary sinus reducer therapy due to its significant anti-myocardial ischemia effect ( 57 ).…”