A new treatment modality for the treatment of unligated thoracic side branch of left internal mammary artery: Underexpanded stent

Year 2024, Volume: 5 Issue: 1, 42 - 45, 30.01.2024

Uğur Küçük , Bahadır Kırılmaz , Emine Gazi , H. Fatih Aşgün , Uğur Özpınar

https://doi.org/10.47482/acmr.1374372

Abstract

The left internal mammary artery (LIMA) is often preferred in coronary artery bypass grafting (CABG). LIMA has additional features such as less fenestration in the endothelial layer, less intercellular permeability, anti-thrombotic activity, rapid lipolysis, and less lipid synthesis, resulting in an excellent long-term patency rate. LIMA side branches or anatomical variations that are not ligated intraoperatively may cause coronary ischemia in the postoperative period. Although various treatment modalities such as coiling, vascular plug embolization, and surgical ligation have been described in treating LIMA side branches, no studies show the superiority of one treatment modality over another. In this case, the advantages, disadvantages, and critical points affecting the success of unligated LIMA side branches treatment methods were discussed.

Keywords

Coronary artery Bypass, stents, Internal Mammary-Coronary Artery, Anastomosis

References

• Ties D, van Dorp P, Pundziute G, Lipsic E, van der Aalst CM, Oudkerk M, et al. Multi-Modality imaging for prevention of coronary artery disease and myocardial Infarction in the general population: Ready for prime time? J Clin Med. 2022;11(11):2965.
• Halabi AR, Alexander JH, Shaw LK, Lorenz TJ, Liao L, Kong DF et al. Relation of early saphenous vein graft failure to outcomes following coronary artery bypass surgery. Am J Cardiol. 2005;96(9):1254-9.
• Guzon OJ, Klatte K, Moyer A, Khoukaz S, Kern MJ. Fallacy of thoracic side-branch steal from the internal mammary artery: analysis of left internal mammary artery coronary flow during thoracic side-branch occlusion with pharmacologic and exercise-induced hyperemia. Catheter Cardiovasc Interv. 2004;61(1):20-8.
• Weinberg N, French WJ, Shavelle DM. Use of the Amplatzer Vascular Plug for treatment of coronary steal. Int J Cardiol. 2008;124(1):109-11.
• Akilli A, Duygu H, Erturk U, Yildiz A, Zoghi M, Ozerkan F. Transbrachial coil occlusion of unligated thoracic side branch of arterial graft of internal mammary artery leading to silent ischemia in a diabetic patient. Int J Cardiol. 2006;113(1):16-8.
• Cleveland JC Jr, Shroyer AL, Chen AY, Peterson E, Grover FL. Offpump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg. 2001; 72(4):1282-1289.
• Nakamura T, Yamamoto S, Funayama H, Mitsuhashi T, Momomura SI. Acute occlusion of the left internal mammary artery graft in the late postoperative period. J Cardiol Cases. 2014; 10(2):51-53.
• Keskin K, Yıldız SS, Çetinkal G, Kilci H, Çalışkan N, Keskin EB, et al. The Association of Plasma Apelin Levels with Plaque Vulnerability. Sisli Etfal Hastan Tip Bul. 2019;53(3):267-271.
• Singh RN, Sosa JA. Internal mammary artery--coronary artery anastomosis. Influence of the side branches on surgical result. J Thorac Cardiovasc Surg. 1981;82(6):909-14.
• Biceroglu S, Karaca M, Yildiz A, Ildizli Demirbas M, Yilmaz H. Can left internal mammary artery side branches affect blood flow rate? Cardiovasc J Afr. 2009;20(2):119-21.
• Yorgun H, Canpolat U, Kaya EB, Çil B, Aytemir K, Oto A. The use of Amplatzer Vascular Plug(®) to treat coronary steal due to unligated thoracic side branch of left internal mammary artery: four year followup results. Cardiol J. 2012;19(2):197-200.
• Gercken U, Lansky AJ, Buellesfeld L, Desai K, Badereldin M, Mueller R, et al. Results of the Jostent coronary stent graft implantation in various clinical settings: procedural and follow-up results. Catheter Cardiovasc Interv. 2002;56(3):353-360.