Use of stents to treat kinks causing obstruction in a left internal mammary artery graft

Rerkpattanapipat, Pairoj; Ghassemi, Rex; Ledley, Gary S.; Wongpraparut, Nattawut; Bemis, Charles E.; Yazdanfar, Shahriar; Kotler, Morris N.

doi:10.1002/(sici)1522-726x(199902)46:2<223::aid-ccd24>3.0.co;2-b

Cited by 20 publications

(21 citation statements)

References 13 publications

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“…The literature cites a low overall incidence of atherosclerosis of the internal thoracic artery [1][2][3]. Most occlusive lesions in the internal thoracic artery following bypass grafting are located in the vessel's distal segment and usually ascribed to technical issues, myointimal hyperplasia at the anastamosis, and graft flow-related problems [4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous intervention directed at lesions in the internal thoracic artery has been described as a relatively safe procedure both from an ipsilateral (brachial or radial) or femoral approach [6][7][8][9][10]. Concerns about the safety of such procedures center around the fragility of the internal thoracic, especially at its ostium, tortuosity of the body of the vessel, and the possibility of significant hemorrhage following perforation [6,11].…”

Section: Discussionmentioning

confidence: 99%

“…Concerns about the safety of such procedures center around the fragility of the internal thoracic, especially at its ostium, tortuosity of the body of the vessel, and the possibility of significant hemorrhage following perforation [6,11]. Few cases of percutaneous intervention at the ostium of the internal thoracic have been reported, but both PTCA and stenting have been associated with high rates of technical success but a relatively high incidence of restenosis, potentially presenting as sudden cardiac death [12,13].…”

Section: Discussionmentioning

confidence: 99%

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Cutting balloon and stenting of a stenosis at the origin of the left internal thoracic artery

2011

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Catheterization was performed in a 58-yearold female with chest pain, which exposed a high-grade stenosis of the ostium of the left internal thoracic artery. Bypass had been completed three years earlier. Successful percutaneous intervention was performed utilizing a cutting balloon and a stent. Brief Clinical HistoryA 58-year-old woman underwent coronary artery bypass surgery three years prior to presentation for chest pain. Three native vessels were bypassed (left internal thoracic to left anterior descending, saphenous vein to second obtuse marginal, and saphenous vein to right coronary artery). Additional medical history included an abdominal aortic endarterectomy (eight years before presentation), peripheral arterial disease with intermittent right leg claudication, a remote history of myocardial infarction, hypertension, and type II diabetes mellitus. She was a reformed smoker with a thirty pack-year history having quit six years before presentation.Approximately one week before presentation she was awakened from sleep by retrosternal chest heaviness. Over subsequent days she noticed recurrence of the chest pressure with activity. She eventually sought care at a community hospital and was admitted with unstable angina. Vitals were as follows; BP 146/66, HR 72, RR 20, height 62 inches, weight 71 kg. She was without jugular venous dilatation. No carotid bruit was auscultated. The heart was regular with normal first and second heart sounds. No murmur was noted. Pulmonary and abdominal examinations were normal. Distal pulses in the upper extremities and left lower extremity were normal; however distal pulses were diminished in the right lower extremity in the femoral, posterior tibial, and dorsalis pedis arteries. A resting ECG was obtained in normal sinus rhythm. Laterally, non-specific T wave abnormalities were noted. A dual-isotope adenosine SPECT study was performed. Post-adenosine images exhibited a large, reversible anteroapical defect. Diagnostic and Interventional CatheterizationCoronary angiography was performed via the left common femoral artery using 6F diagnostic catheters (JL4, JR4). The left femoral site was selected due to the patient's history of intermittent claudication on the right. All native coronary vessels were chronically totally occluded. The venous grafts (to OM2 and the RCA) were widely patent. The left internal thoracic graft was sub-selectively injected. A 99% occlusion of the ostium of the internal thoracic vessel was noted ( Figure 1). Semi-selective injections were then performed to avoid catheter damping. Injections of nitroglycerine were done to differentiate spasm from true stenosis, and no changes were observed. The vessel was free of any luminal narrowing distal to the ostium. Additionally, no anastamotic lesion was seen. A left ventriculogram was performed which showed mildly impaired LV systolic function with apical dyskinesis and an overall ejection fraction of 45%.Percutaneous intervention was performed the following day. The left groin was selected because of the dimini...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cutting balloon and stenting of a stenosis at the origin of the left internal thoracic artery

2011

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“…In newly placed LIMAs the situation is different. In this context, there can be several reasons for graft failure, including inadequate conduit size, damage to the artery during operative preparation, postoperative stretching of the graft by hyperinflated lungs, a kink [13], and inaccurate placement of vascular clips or surgical sutures in the side branches [8]. This explains why these lesions are usually located in the body of the graft, as in our two cases, and why they represent a dilemma in terms of therapy when they are encountered by interventional cardiologists.…”

Section: Discussionmentioning

confidence: 99%

“…This explains why these lesions are usually located in the body of the graft, as in our two cases, and why they represent a dilemma in terms of therapy when they are encountered by interventional cardiologists. As an alternative to surgical correction, some types of lesions in newly placed LIMAs, such as kinks, can be treated successfully by stent implantation [13]. In the two cases we report, stent deployment was complicated by vessel rupture.…”

Section: Discussionmentioning

confidence: 99%

Left internal mammary artery graft perforation repair using polytetrafluoroethylene-covered stents

Albiero

Nishida

Corvaja

et al. 2000

Cathet. Cardiovasc. Intervent.

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The increase in the use of the left internal mammary artery (LIMA) as graft of choice to the left anterior descending coronary artery for conventional and minimally invasive coronary artery bypass surgery has led to an increased incidence of LIMA pathologic lesions early after surgery. The lesion, commonly located in the body of the LIMA graft, is usually caused by mechanical injury during harvesting of the vessel. In this context, percutaneous intervention with stent implantation can be complicated by vessel rupture, which usually requires emergency surgical repair. We describe two cases of stent implantation in newly placed LIMA grafts complicated by vessel rupture, which were successfully repaired using polytetrafluoroethylene-covered stents.

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Stenting for spontaneous left internal mammary artery dissection: A case report

Ziaee

Puri

Kern

2003

Cathet Cardio Intervent

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Use of stents to treat kinks causing obstruction in a left internal mammary artery graft

Cited by 20 publications

References 13 publications

Cutting balloon and stenting of a stenosis at the origin of the left internal thoracic artery

Cutting balloon and stenting of a stenosis at the origin of the left internal thoracic artery

Left internal mammary artery graft perforation repair using polytetrafluoroethylene-covered stents

Stenting for spontaneous left internal mammary artery dissection: A case report

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