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Shammas NW, Karia R. Iatrogenic Intramural Hematoma Identified by Intravascular Ultrasound Following Selective Angiography of the Left Internal Mammary Artery. JACC Case Rep 2019; 1:127-130. [PMID: 34316767 PMCID: PMC8301241 DOI: 10.1016/j.jaccas.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/13/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
Abstract
This case reports on iatrogenic intramural hematoma of the left internal mammary artery (LIMA) identified on intravascular ultrasound. This case illustrates the importance of intravascular imaging to identify the presence and extent of an intraluminal hematoma that is not visualized on angiography and that was the cause of ischemic symptoms following LIMA injection. (Level of Difficulty: Advanced.)
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Affiliation(s)
| | - Rusina Karia
- Midwest Cardiovascular Research Foundation, Davenport, Iowa
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2
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Oh JS, Choi BG, Chun HJ, Lee HG. A side-hole catheter for catheterization of a difficult internal mammary artery. Acta Radiol 2017; 58:307-310. [PMID: 27083204 DOI: 10.1177/0284185116642633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The internal mammary artery (IMA) can be a source of hemoptysis in patients with chronic lung disease. Intervention via the IMA can be a challenge due to anatomic variations and lead to excessive contrast use and radiation exposure. Purpose To evaluate safety and efficiency of a new side-hole catheter for the catheterization of the IMA in patients with hemoptysis. Material and Methods From January 2011 to August 2014, a total of 96 transarterial embolization procedures required exact evaluation of the IMA due to chronic lung disease involving the anterior thorax. In 17 cases (18%) of these 96 procedures, the conventional selective IMA angiography failed and instead a novel side-hole catheter as a modification of a cobra-type curved catheter was used. The side hole allowed passage of a micro-wire and catheter. Results Failed catheterizations were due to severe vascular tortuosity, acutely angulated subclavian artery, or abnormal takeoff of the IMA. The Cobra shaped catheter with the microcatheter through the side-hole catheter yielded a technical success rate of 100%. Longer time was required to catheterize the IMA with the Cobra shaped catheter than with the side-hole catheter (17 vs. 2 min, P < 0.05). There were no procedure-related complications. Conclusion Side-hole catheter technique is useful in patients whose internal mammary artery is difficult to access. Further design revisions are needed to improve the ease and speed of IMA catheterization and angiography.
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Affiliation(s)
- Jung Suk Oh
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Byung Gil Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Ho Jong Chun
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Hae Giu Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
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3
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Khan Z, Latif F, Dasari TW. Internal mammary artery graft dissection: a case-based retrospective study and brief review. Tex Heart Inst J 2014; 41:653-6. [PMID: 25593535 DOI: 10.14503/thij-13-3615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The left internal mammary artery is the preferred graft for treating left anterior descending coronary artery disease. Dissection is a rare but grave sequela of internal mammary artery graft angiography. The available medical literature is scant, perhaps as a result of under-reporting. We report a case in which dissection of the internal mammary artery graft occurred during diagnostic angiography, and we discuss its management. In addition, we review the available literature and provide a retrospective analysis of the data from our own catheterization laboratory. In our single-center analysis of 542 cases of selective internal mammary artery graft angiography, we found only the single case of internal mammary artery graft dissection (0.2%) that we report here. Our review of the literature revealed 7 reported cases of internal mammary artery graft dissection, 3 of which were iatrogenic. There were no identifiable risk factors for such dissection. After treatment with angioplasty and stenting, all patients had good outcomes during follow-up.
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4
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Lee JH, Kim MJ, Cha KS, Choi JH, Lee SY, Nam YH, Park JS, Chung SH, Kum DS, Park TH, Kim MH, Kim YD. The feasibility of bypass graft angiography by right radial access. Korean Circ J 2009; 39:304-9. [PMID: 19949635 PMCID: PMC2771843 DOI: 10.4070/kcj.2009.39.8.304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 10/14/2008] [Accepted: 10/16/2008] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives Left transradial coronary angiography may result in damage of both radial arteries in patients who experienced right radial access. In some patients, the left radial artery has been used as a graft. We investigated whether graft angiography using right radial access is feasible in patients with bypass surgery to preserve the left radial artery as a future graft. Subjects and Methods A total of 109 consecutive patients with bypass surgery who had undergone right radial access underwent graft angiography via the same access. Results Sixteen (15%) patients were excluded because of the presence of a severely tortuous right subclavian artery. Bypass graft angiography via right radial or brachial access was completed successfully in 90 (97%) out of 93 patients. In 3 (3%) of patients, femoral access was needed to complete the angiography. Saphenous vein grafts were cannulated selectively in 150 (90%) of 167 grafts with satisfactory image quality and not found even on the aortogram in the other 17 (10%) grafts. Ninety-two (89%) out of 103 left mammary grafts were cannulated selectively or semi-selectively using a modified Simmons catheter, resulting in satisfactory image quality. The other 11 (11%) grafts were visualized non-selectively using a Judkins Left catheter, and resulting in acceptable image quality in 10 (91%) grafts. There were no procedure-related complications. Conclusion Graft angiography via right radial access can be performed reliably in most patients that lack severe subclavian tortuosity.
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Affiliation(s)
- Jae Hoon Lee
- Cardiology Division, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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5
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Ierna S, Belli R, Giammaria M, Beqaraj F, Imazio M, Trinchero R. Successful angioplasty and stenting of bilateral internal mammary artery grafts from the left radial approach. Case report and review of the literature. J Cardiovasc Med (Hagerstown) 2007; 8:531-4. [PMID: 17568288 DOI: 10.2459/01.jcm.0000278441.74117.b7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a case of successful percutaneous transluminal coronary angioplasty and stenting from the left radial approach in a patient with effort angina due to two tight stenoses at the distal anastomosis site of the internal mammary artery grafts. The left radial approach has several advantages compared with the conventional femoral approach: a lower rate of vascular complications and an easier vascular access to the left internal mammary artery graft. The distance from the access site to the origin of the artery is shorter and involves less angulation than the femoral approach. The radial approach is not only safe but it enables faster patient mobilisation and seems also useful in reducing management costs with a hospital stay that can be reduced to 6 h in low-risk cases.
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Affiliation(s)
- Salvatore Ierna
- Cardiology Department, Maria Vittoria Hospital, ASL 3, Turin, Italy.
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6
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Skowasch D, Lüderitz B, Bauriedel G. Left internal mammary angiography complicated by subclavian tortuosity: a technical note. J Interv Cardiol 2005; 18:309-11. [PMID: 16115165 DOI: 10.1111/j.1540-8183.2005.00046.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Current elective bypass procedures frequently involve placement of a left internal mammary artery (LIMA). Accordingly, there is an increased need to prove either preoperative adequacy or postoperative patency of this graft. We report a patient with a tortuous left subclavian artery inaccessible for any standard catheterization technique for LIMA opacification. The problem was overcome by a CHOICE PT guidewire whose trackability permitted the passage through the subclavian kinking and, subsequently, to coaxially advance a multipurpose catheter to the entrance of the LIMA. The described setting may be helpful for diagnostic LIMA imaging in selected cases.
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Affiliation(s)
- Dirk Skowasch
- Department of Cardiology, University of Bonn, Bonn, Germany
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7
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Hadase M, Kawasaki T, Asada S, Kamitani T, Kawasaki S, Sugihara H. The YUMIKO catheter: a useful tool for angiography of the right internal mammary artery via a right brachial approach. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2003; 5:98-101. [PMID: 12745869 DOI: 10.1080/14628840310003325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The YUMIKO catheter (Goodman, Nagoya, Japan) was recently developed for a left internal mammary artery (IMA) angiography with a right radial or brachial approach. The present authors experienced an interesting case where the YUMIKO catheter was useful for a right IMA angiography via a right brachial artery. A 53-year-old man with bilateral IMA grafts underwent follow-up coronary angiography via a right brachial artery. Native coronary artery and left IMA angiography were performed without difficulty using the Judkins Right and Left and YUMIKO catheters. Angiography of the right IMA was attempted with the Judkins Right catheter and IMA catheter, resulting in a nonselective angiogram with poor imaging. The YUMIKO catheter, however, enabled smooth cannulation to the right IMA and provided good images of the selective right IMA angiography.
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Affiliation(s)
- Mitsuyoshi Hadase
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan.
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8
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Cha KS, Kim MH. Feasibility and safety of concomitant left internal mammary arteriography at the setting of the right transradial coronary angiography. Catheter Cardiovasc Interv 2002; 56:188-95. [PMID: 12112911 DOI: 10.1002/ccd.10164] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We investigated the feasibility and safety of concomitant left internal mammary artery (LIMA) angiography at the setting of the right transradial coronary angiography (TRCA). LIMA angiography was performed using a 5 Fr Simmons-type catheter with a newly modified tip in 184 consecutive patients. The catheter was reformed in the descending (new method) or ascending (traditional method) aorta and manipulated to cannulate the left subclavian artery and LIMA orifice. LIMA angiography was performed selectively in 164 patients (89%) and semiselectively (when the catheter tip reached and was directed to the mammary artery orifice) in 20 patients. There were no procedure-related complications. The image quality of all the semiselective angiograms was also determined satisfactory. Total procedural time was 223 +/- 168 sec. The catheter was reformed using the new method in 160 patients (87%). The catheter reformation time and total procedure time were significantly shorter with the new method than with the traditional method (18 +/- 8 vs. 117 +/- 115 sec, p = 0.000; 204 +/- 191 vs. 309 +/- 139 sec, p = 0.021, respectively). In conclusion, LIMA angiography can be performed readily and safely at the setting of the right TRCA using a Simmons-type catheter. The image quality of the LIMA angiograms is sufficient to obviate the need of the second preoperative angiography via another route.
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Affiliation(s)
- Kwang Soo Cha
- Department of Internal Medicine, Dong-A University Hospital, Pusan, South Korea.
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9
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Miyake Y, Inoue T, Morooka S, Ando H, Shimizu M. A novel method for angiography of the left internal thoracic artery from a right arm approach using a YUMIKO-LITA catheter. Am J Cardiol 2002; 89:984-6. [PMID: 11950443 DOI: 10.1016/s0002-9149(02)02254-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yumiko Miyake
- Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan.
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10
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Kim MH, Cha KS, Kim HJ, Kim JS. Bilateral selective internal mammary artery angiography via right radial approach: clinical experience with newly designed Yumiko catheter. Catheter Cardiovasc Interv 2001; 54:19-24. [PMID: 11553943 DOI: 10.1002/ccd.1232] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The radial artery has been increasingly used as a primary access site for coronary angiography and intervention. But the technique for internal mammary artery (IMA) visualization via the right radial artery has not been well described. Therefore, the study was conducted to investigate the feasibility, safety, and adequacy of selective bilateral IMA angiography via the right radial artery using the recently developed Yumiko catheter. From November 1999 to October 2000, both IMA angiographies were undertaken immediately following the diagnostic coronary angiogram taken from right transradial approach in 114 patients. IMA angiography was successfully obtained in 99% (113/114) patients. For left IMA angiography, 73 (64%), 28 (25%), and 12 (11%) imagings were obtained in a selective, a semiselective, and a nonselective way, respectively. After initial periods of 33 left-IMA-only imaging, right IMA angiography was obtained in 81 patients (phase 2). Selective right IMA imaging was done in 73 (90%), semiselective in 6, and nonselective in 2 patients. The reasons for failure of selective or semiselective visualization were severe vascular tortuosity, far distal anatomical origin of left IMA and ulcerative plaque, or acutely angled left subclavian artery. The feasibility and safety of selective and semiselective bilateral IMA angiography were demonstrated using a 5 Fr Yumiko catheter from the right radial approach. Cathet Cardiovasc Intervent 2001;54:19-24.
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Affiliation(s)
- M H Kim
- Section of Cardiology, Dong-A Medical College, Seo-Gu, Pusan, South Korea.
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11
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English JA, Carell ES, Guidera SA, Tripp HF. Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization. Catheter Cardiovasc Interv 2001; 54:8-11. [PMID: 11553941 DOI: 10.1002/ccd.1230] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The angiographic prevalence, clinical predictors, and sensitivity and specificity of a bilateral arm blood pressure differential for predicting proximal left subclavian artery stenosis were established in 492 patients undergoing cardiac catheterization. Seventeen subjects (3.5%) in the overall population and nine subjects (5.3%) with potential surgical coronary disease had proximal left subclavian stenosis. Precatheterization evidence of peripheral vascular disease (PVD) was the only predictor of subclavian stenosis in the overall population (P < 0.001; OR = 7.9; 95% CI = 2.6-24.3) and in patients with potential surgical coronary disease (P = 0.04; OR = 5.4; 95% CI = 1.1-27.2). Both a bilateral blood pressure differential of > 10 mm Hg and of > or =20 mm Hg had a good specificity but a poor sensitivity for predicting left subclavian stenosis. Thus, left subclavian angiography should be performed in patients with surgical coronary disease with either an arm blood pressure differential of > 10 mm Hg or with other precatheterization evidence of PVD. Cathet Cardiovasc Intervent 2001;54:8-11.
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Affiliation(s)
- J A English
- Department of Cardiology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, USA
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12
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Finet G, Rioufol G, Roriz R, Abrysch F, de Gévigney GD, Revel D, André-Fouët X, Bonnefoy E, Ovize M, Beaune J. A new right internal mammary artery-specific diagnostic catheter: initial clinical experience. Catheter Cardiovasc Interv 1999; 48:226-9. [PMID: 10506787 DOI: 10.1002/(sici)1522-726x(199910)48:2<226::aid-ccd24>3.0.co;2-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- G Finet
- Department of Hemodynamics, Hospices Civils de Lyon and Claude Bernard University, Lyon, France.
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13
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Zheng H, Pentousis D, Corcos T, Favereau X, Guérin Y, Ouzan J, Toussaint M. Bilateral internal mammary angiography through a right radial approach: a case report. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 45:188-90. [PMID: 9786401 DOI: 10.1002/(sici)1097-0304(199810)45:2<188::aid-ccd18>3.0.co;2-h] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This case report demonstrates that bilateral internal mammary angiography through a single right-radial approach is feasible and convenient. It avoids double-brachial or radial artery puncture, is adapted to the variable characteristics of right internal mammary artery origin, and may be considered when the femoral approach is contraindicated.
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Affiliation(s)
- H Zheng
- Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
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14
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Berger SR, Kurnik PB, Waxman HL, Groh WC, Untereker WJ, Matthai WH. Internal mammary arteriography without selective cannulation using a new balloon occlusion catheter. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 39:198-202. [PMID: 8922326 DOI: 10.1002/(sici)1097-0304(199610)39:2<198::aid-ccd20>3.0.co;2-c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Internal mammary artery (IMA) angiography can be difficult and time-consuming. We evaluated a custom designed balloon-tipped catheter, a Berman catheter (Arrow International, Reading, PA) modified by creating an end-hole to allow passage of a wire through the central lumen, for imaging the IMA without selective cannulation. We compared ease of use, procedure time, and image quality of the new catheter with the standard selective catheter technique. Thirty-six patients with IMA grafts were randomly assigned to imaging with either the study catheter or a standard catheter. Image quality, graded from poor to excellent, time to catheter placement in the subclavian artery (TIME 1), time to initial IMA angiography (TIME 2), and the difference between these two (TIME 3) were recorded. TIME 3 defined the time required to find and seat the catheter at the IMA site. The image quality was good or excellent in all but one patient. This one patient, randomized to the standard catheter technique, had poor image quality with the selective catheter. However, exchange for the study catheter resulted in excellent image quality. There was no difference in TIME 1 (P = 0.57) or TIME 2 (P = 0.55) between the two techniques. There was a significant difference in TIME 3 (P = 0.05) favoring the study catheter. There were no complication using either technique and the total contrast volume used was not significantly different between the two techniques (P = 0.32). We conclude that a new catheter technique for imaging the IMA without selective cannulation is safe, fast, easy to use, and may offer particular advantage in patients whose internal mammary artery is difficult to access.
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Affiliation(s)
- S R Berger
- Department of Medicine, UMDNJ/Robert Wood Johnson Medical School at Camden, USA
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15
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Rabah MM, Gangadharan V, Brodsky M, Safian RD. Unstable coronary ischemic syndromes caused by coronary-subclavian steal. Am Heart J 1996; 131:374-8. [PMID: 8579036 DOI: 10.1016/s0002-8703(96)90369-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M M Rabah
- Department of Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA
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16
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Abstract
Two cases of transient cortical blindness during coronary and graft angiography are described. In both cases, the onset of blindness was immediately preceded by manipulation of a guidewire in the left subclavian artery during attempts to selectively engage the internal mammary artery. Vertebral angiography was performed in the first patient and the appearances were compatible with multiple emboli in the posterior circulation. This patient was anticoagulated with intravenous heparin. His vision recovered within 72 h, but a mild visual agnosia persisted and it was only after nearly 3 weeks that all neurological deficits had resolved. The second patient recovered fully within 15 min. We postulate that emboli occurring as a result of manipulation of the guidewire close to the origin of the left vertebral artery was the cause of the cortical blindness in both these patients, although vasospasm as a contributory factor cannot be excluded. With an increasing need for investigation of patients after coronary artery bypass grafting, angiographers should be aware that selective internal mammary graft angiography may carry a higher than normal risk of neurological complications. The use of a guidewire to manipulate the catheter in the subclavian artery may increase this risk.
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Affiliation(s)
- J S Skinner
- Department of Cardiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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17
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Bhatt SN, Jorgensen MB, Aharonian VJ, Mahrer PR. Nonselective angiography of the internal mammary artery: a fast, reliable, and safe technique. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 36:194-8. [PMID: 8829846 DOI: 10.1002/ccd.1810360225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Selective cannulation of the mammary artery can be time consuming and carries a risk of arterial injury. The nonselective technique described here is faster, safer, and as reliable as the standard selective technique. A consecutive series of patients with previous coronary artery bypass graft surgery (CABG) were randomized to undergo either selective or nonselective mammary artery angiography. Selective angiography was performed using the standard selective technique. Nonselective angiography was performed by placing a standard catheter in the subclavian artery and hand injecting 10 ml of contrast while inflating a blood pressure cuff 10 mm above the systolic pressure in the ipsilateral arm. Fifty-six patients were studied, 30 patients selectively, and 26 patients nonselectively. The time to visualize adequately both native and grafted mammary arteries in the selective group was 4.83 + 5.00 min and in the nonselective group 1.76 + 1.16 minutes (P = 0.006). A nonselective technique for visualizing the mammary artery is significantly faster and as reliable as the standard selective technique.
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Affiliation(s)
- S N Bhatt
- Department of Cardiology/Cardiac Catheterization Laboratory, Kaiser Permanente Medical Center, Los Angeles, California, USA
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18
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Frohwein S, Ververis JJ, Marshall JJ. Subclavian artery dissection during diagnostic cardiac catheterization: the role of conservative management. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 34:313-7. [PMID: 7621540 DOI: 10.1002/ccd.1810340208] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Dissection of the subclavian artery during routine cardiac catheterization while obtaining cannulation to the left internal mammary artery is an unusual complication and to our knowledge has never been reported. Conservative management of this vascular injury can avoid the sequelae of high-risk surgical repairs made difficult by a complex operative exposure. We describe a case in which dissection of the left subclavian artery was treated conservatively with an excellent outcome.
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Affiliation(s)
- S Frohwein
- Cardiology Division, Emory University School of Medicine, Atlanta, Georgia, USA
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19
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Kugelmass AD, Kim D, Kuntz RE, Carrozza JP, Baim DS. Endoluminal stenting of a subclavian artery stenosis to treat ischemia in the distribution of a patent left internal mammary graft. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1994; 33:175-7. [PMID: 7834734 DOI: 10.1002/ccd.1810330221] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Subclavian artery stenosis is a rare cause of recurrent myocardial ischemia in patients who have undergone left internal mammary-coronary artery bypass grafting. A patient with this syndrome was successfully treated by placement of Palmaz biliary stents in the left subclavian artery. Angiographic and hemodynamic evidence of restricted subclavian flow resolved following stenting, as did the patient's unstable angina syndrome. Endoluminal stenting of the proximal subclavian artery for the treatment of coronary-subclavian steal can be performed safely and provides an alternative to other forms of surgical or percutaneous (PTCA, directional atherectomy) revascularization for treatment of this disorder.
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Affiliation(s)
- A D Kugelmass
- Charles A. Dana Research Institute, Boston, Massachusetts
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20
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Parashara DK, Kotler MN, Ledley GS, Yazdanfar S. Internal mammary artery collateral to the external iliac artery: an angiographic consideration prior to coronary bypass surgery. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1994; 32:343-5. [PMID: 7987915 DOI: 10.1002/ccd.1810320411] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The role of routine selective angiography of the internal mammary artery prior to myocardial revascularization is controversial. We report a patient with coronary artery disease and peripheral vascular disease in whom the left internal mammary artery supplied blood flow to the left external iliac artery via a collateral network. Thus, selective angiography of the internal mammary artery did play a major role in the proper management of this patient who required coronary bypass surgery. A major potential postoperative complication of left lower extremity ischemia may have been prevented.
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Affiliation(s)
- D K Parashara
- Department of Medicine, Albert Einstein Medical Center, Temple University School of Medicine, Philadelphia, Pennsylvania 19141
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21
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Breall JA, Grossman W, Stillman IE, Gianturco LE, Kim D. Atherectomy of the subclavian artery for patients with symptomatic coronary-subclavian steal syndrome. J Am Coll Cardiol 1993; 21:1564-7. [PMID: 8496520 DOI: 10.1016/0735-1097(93)90369-c] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study addresses the efficacy of directional atherectomy in the subclavian artery for the relief of angina in patients with the coronary-subclavian steal syndrome. In addition, we review the histologic findings from the atherectomy specimens. BACKGROUND The coronary-subclavian steal syndrome may occur after internal mammary-coronary artery bypass grafting. It is due to a stenosis in the subclavian artery proximal to the origin of the internal mammary artery and causes frank ischemia to the area supplied by the graft. Currently, surgery is the corrective procedure of choice. METHODS In three patients with severe subclavian artery stenoses and unstable angina, directional atherectomy was performed using a peripheral atherectomy catheter through a percutaneous femoral approach. The patients ranged from 43 to 71 years of age and had undergone internal mammary-coronary artery bypass grafting 3 to 10 years previously. Each patient had severe peripheral vascular and cerebrovascular disease. RESULTS All three patients had immediate symptomatic relief after the atherectomy, and postprocedure exercise testing demonstrated improved cardiac function. Two patients remain asymptomatic at 7 and 8 months, respectively; the third patient developed unstable angina 9 months later because of severe restenosis that was again successfully treated with atherectomy. Histologic examination of the specimens revealed atherosclerotic plaque, occasionally with adventitia. The specimen from the repeat atherectomy showed severe intimal hyperplasia. CONCLUSIONS Directional atherectomy appears to be a safe and effective treatment for coronary-subclavian steal syndrome. This procedure may be the treatment of choice for patients in whom a vascular bypass operation is not feasible.
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Affiliation(s)
- J A Breall
- Charles A. Dana Research Institute, Beth Israel Hospital, Boston, MA 02215
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Feit A, Reddy CV, Cowley C, Ibrahim B, Zisbrod Z. Internal mammary artery angiography should be a routine component of diagnostic coronary angiography. ACTA ACUST UNITED AC 1992; 25:85-90. [PMID: 1347484 DOI: 10.1002/ccd.1810250202] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Left internal mammary artery (LIMA) angiography was performed with diagnostic coronary angiography in 130 cases for which the coronary findings made use of the LIMA as a bypass graft a consideration. In 98% of the cases the approach to LIMA angiography was femoral with a 5F LIMA catheter first directed into the proximal subclavian and then advanced over a guidewire placed into the distal subclavian well beyond the origin of the LIMA. After withdrawing the wire the catheter was brought proximally to selectively cannulate and visualize the LIMA with nonionic contrast media. The only complication was a single transient occipital visual field loss. LIMA caliber too narrow to permit use as a graft was found twice, LIMA occlusion unrelated to prior surgery was found once, and LIMA occlusion related to prior surgery was found twice. Subclavian and/or vertebral stenosis was present five times. Large proximal branches of the LIMA best identified prior to surgery were present 12 times. Based on this experience, LIMA angiography 1) can be performed safely with a high degree of success, 2) demonstrates significant findings in 15% of cases, and 3) should therefore be performed whenever coronary angiographic findings make it appropriate to consider LIMA to coronary artery bypass grafting.
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Affiliation(s)
- A Feit
- Department of Medicine, State University of New York Health Science Center, Brooklyn 11203
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23
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Brown RI, Galligan L, Penn IM, Weinstein L. Right internal mammary artery graft angioplasty through a right brachial artery approach using a new custom guide catheter: A case report. ACTA ACUST UNITED AC 1992; 25:42-5. [PMID: 1348212 DOI: 10.1002/ccd.1810250109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Angioplasty of right internal mammary artery grafts may present problems because of the variable origin of the mammary artery and its angulation from the subclavian artery. We report a case of successful angioplasty using a custom designed guide catheter, after failed attempts using conventional guide catheters.
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Affiliation(s)
- R I Brown
- Division of Cardiology, Victoria Hospital Corp., London, Ontario, Canada
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Breall JA, Kim D, Baim DS, Skillman JJ, Grossman W. Coronary-subclavian steal: an unusual cause of angina pectoris after successful internal mammary-coronary artery bypass grafting. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 24:274-6. [PMID: 1756564 DOI: 10.1002/ccd.1810240412] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Coronary-subclavian steal syndrome is a rare cause of angina pectoris after bypass grafting using the internal mammary artery. We report the 11th case in the literature and review the pathophysiology and treatment of this disorder. We also review appropriate screening for this possibly increasing, yet preventable disorder.
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Affiliation(s)
- J A Breall
- Charles A. Dana Research Institute, Boston, Massachusetts
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