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Datta T, Gibreal M, Mazhari R, Solomon AJ. Percutaneous management of ostial stenosis of the left internal mammary artery graft. Oxf Med Case Reports 2018; 2018:omx082. [PMID: 29670747 PMCID: PMC5903413 DOI: 10.1093/omcr/omx082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/24/2017] [Accepted: 10/29/2017] [Indexed: 11/16/2022] Open
Abstract
A 61-year-old man, who had undergone coronary artery bypass surgery 10 years earlier, presented with a non-ST segment elevation myocardial infarction. He was treated with medical therapy and taken to the Cardiac Catheterization Laboratory. A left heart catheterization demonstrated an ostial stenosis in the left internal mammary artery graft, which was felt to be the culprit lesion. This was successfully repaired with a drug eluting stent. This case is presented as an unusual location for a de novo coronary stenosis. The pathophysiology of these lesions is not well understood.
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Affiliation(s)
- Tanuka Datta
- Department of Internal Medicine, The George Washington University, Washington, DC 20037, USA
- Correspondence address. Internal Medicine, The George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA. Tel: +1-202-741-2222; Fax: +1-202-741-2427; E mail:
| | - Mohammed Gibreal
- Department of Internal Medicine, Division of Cardiology, The George Washington University, Washington, DC 20037, USA
| | - Ramesh Mazhari
- Department of Internal Medicine, Division of Cardiology, The George Washington University, Washington, DC 20037, USA
| | - Allen J Solomon
- Department of Internal Medicine, Division of Cardiology, The George Washington University, Washington, DC 20037, USA
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Passaloglou IT, Sabashnikov A, Zeriouh M, Reutter S, Fatullayev J, Choi YH, Wahlers T. Rapid diagnostics and treatment of early complications after CABG surgery: a life saver. Heart Surg Forum 2013; 16:E346-50. [PMID: 24370805 DOI: 10.1532/hsf98.2013244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Early graft failure after CABG surgery may lead to severe adverse events and death. Because the cause of the graft failure can vary, rapid diagnostic management is mandatory in order to address these complications appropriately. In the present 2 cases, patients who underwent CABG procedures showed typical electrocardiograms and serology of a perioperative myocardial ischemia shortly after surgery. In the first case, a rapidly performed coronary angiogram revealed a torqued right CABG, which was detorqued and, in order to avoid further torsion, fixated to the pericardium in a redo procedure. In the second case, the patient underwent a revascularization by means of percutaneous coronary intervention with stent implantation for severe stenosis due to a localized dissection of the vein graft, diagnosed on coronary angiogram. The further postoperative course of both patients was smooth and both could be discharged on day 8 and 11 after initial surgery, respectively.
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Affiliation(s)
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Stefanie Reutter
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Javid Fatullayev
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
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3
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Smith SC, Feldman TE, Hirshfeld JW, Jacobs AK, Kern MJ, King SB, Morrison DA, O'Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006; 47:e1-121. [PMID: 16386656 DOI: 10.1016/j.jacc.2005.12.001] [Citation(s) in RCA: 309] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Tengiz I, Aliyev E, Ercan E. An alternative percutaneous interventional approach for post-anastomatic left anterior descending artery stenosis in patients with markedly tortuous LIMA graft. Int J Cardiovasc Imaging 2006; 21:491-4. [PMID: 16175436 DOI: 10.1007/s10554-005-0369-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 01/10/2005] [Indexed: 10/25/2022]
Abstract
Percutaneous coronary intervention through a tortuous left internal mammary artery (LIMA) graft, especially with redundancy in length is a challenge in spite of availability of different types of coated guidewires and low-profile balloons. Various modifications of the interventional technique are required in order to negotiate the tortuosity of the LIMA graft. We describe an alternative technique that overcomes this problem in patient with a markedly tortuous LIMA graft.
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Affiliation(s)
- Istemihan Tengiz
- Department of Cardiology, Central Hospital, 35010, Bayrakli, Izmir, Turkey.
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Sharma AK, McGlynn S, Apple S, Pinnow E, Canos DA, Gevorkian N, Tebeica M, Gruberg L, Pichard AD, Lindsay J. Clinical outcomes following stent implantation in internal mammary artery grafts. Catheter Cardiovasc Interv 2003; 59:436-41. [PMID: 12891602 DOI: 10.1002/ccd.10580] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We evaluated our experience with percutaneous coronary intervention (PCI) of internal mammary artery (IMA) grafts. From the institution's database we identified 288 patients with 311 IMA lesions. Of these, 82 (26.4%) had stents placed during PCI. Angiographic success was 92%. Mortality at 1 month was 1.7%, myocardial infarction (MI) 15.7%, and target lesion revascularization (TLR) 0.4%. Cumulative 1-year event rates were mortality 6.4%, MI 20.4%, and TLR 8.0%. TLR rates were significantly higher in the stented lesions than lesions treated with angioplasty alone (19.2% vs. 4.9%; P = 0.004). The higher TLR rate in stented lesions was most apparent at the anastomotic site (25.0% vs. 4.2%; P = 0.006). Percutaneous revascularization of IMA grafts can be performed safely with high procedural success and excellent short- and long-term results. Stenting, particularly at the anastomotic site, was associated with significantly greater rates of TLR than angioplasty alone.
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Affiliation(s)
- Arvind K Sharma
- Department of Cardiology, Washington Hospital Center, Washington, DC 20010, USA
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Sharma AK, Ajani AE, Garg N, GebreEyesus A, Varghese J, Pinnow E, Waksman R, Pichard AD, Lindsay J. Percutaneous interventions in radial artery grafts: clinical and angiographic outcomes. Catheter Cardiovasc Interv 2003; 59:172-5. [PMID: 12772234 DOI: 10.1002/ccd.10527] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the modern era, radial artery graft is being used with increasing frequency to replace saphenous vein as a conduit for coronary artery bypass surgery. Several reports have shown encouraging early results of radial grafts compared to saphenous grafts. Despite these advantages, radial artery graft failure requiring revascularization does occur. We report on the clinical, angiographic, and technical characteristics and the follow-up results of 22 patients who underwent percutaneous intervention of radial grafts.
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Affiliation(s)
- Arvind K Sharma
- Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
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7
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Smith SC, Dove JT, Jacobs AK, Ward Kennedy J, Kereiakes D, Kern MJ, Kuntz RE, Popma JJ, Schaff HV, Williams DO, Gibbons RJ, Alpert JP, Eagle KA, Faxon DP, Fuster V, Gardner TJ, Gregoratos G, Russell RO, Smith SC. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)31This document was approved by the American College of Cardiology Board of Trustees in April 2001 and by the American Heart Association Science Advisory and Coordinating Committee in March 2001.32When citing this document, the American College of Cardiology and the American Heart Association would appreciate the following citation format: Smith SC, Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, Kuntz RE, Popma JJ, Schaff HV, Williams DO. ACC/AHA guidelines for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty). J Am Coll Cardiol 2001;37:2239i–lxvi.33This document is available on the ACC Web site at www.acc.organd the AHA Web site at www.americanheart.org(ask for reprint no. 71-0206). To obtain a reprint of the shorter version (executive summary and summary of recommendations) to be published in the June 15, 2001 issue of the Journal of the American College of Cardiology and the June 19, 2001 issue of Circulation for $5 each, call 800-253-4636 (US only) or write the American College of Cardiology, Educational Services, 9111 Old Georgetown Road, Bethesda, MD 20814-1699. To purchase additional reprints up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1,000 or more copies, call 214-706-1466, fax 214-691-6342, or E-mail: pubauth@heart.org(ask for reprint no. 71-0205). J Am Coll Cardiol 2001. [DOI: 10.1016/s0735-1097(01)01345-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Thomas WJ, Cowley MJ, Vetrovec GW, Malloy W, Goudreau E. Effectiveness of rotational atherectomy in narrowed left internal mammary artery grafts to the left anterior descending coronary artery. Am J Cardiol 2000; 86:86-8. [PMID: 10867099 DOI: 10.1016/s0002-9149(00)00833-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- W J Thomas
- Division of Cardiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia 23298, USA
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Rerkpattanapipat P, Ghassemi R, Ledley GS, Wongpraparut N, Bemis CE, Yazdanfar S, Kotler MN. Use of stents to treat kinks causing obstruction in a left internal mammary artery graft. Catheter Cardiovasc Interv 1999; 46:223-6. [PMID: 10348550 DOI: 10.1002/(sici)1522-726x(199902)46:2<223::aid-ccd24>3.0.co;2-b] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Left internal mammary arteries (LIMA) are used routinely as grafts to the left anterior descending coronary artery (LAD) in selected patients undergoing coronary artery bypass graft (CABG) surgery because of better long-term patency rates. Pathology other than fibrointimal hyperplasia, accelerated atherosclerosis, or thrombus can sometimes cause obstructive lesions in such grafts. This report illustrates a kink in a LIMA graft to the LAD causing an obstructive lesion shortly after surgery and describes the subsequent management of this lesion with intracoronary stents.
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Affiliation(s)
- P Rerkpattanapipat
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA
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Magovern JA, Benckart DH, Landreneau RJ, Sakert T, Magovern GJ. Morbidity, cost, and six-month outcome of minimally invasive direct coronary artery bypass grafting. Ann Thorac Surg 1998; 66:1224-9. [PMID: 9800810 DOI: 10.1016/s0003-4975(98)00808-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Minimally invasive direct coronary artery bypass grafting (MIDCABG) promises to reduce the morbidity of coronary bypass, but this has not been proved. METHODS This retrospective study compares the morbidity, mortality, cost, and 6-month outcome of patients less than 80 years old undergoing elective left internal mammary artery to left anterior descending artery bypass grafting via MIDCABG (n = 60) or sternotomy (n = 55) between January 1995 and December 1996. There were no differences between the groups in mean age, sex distribution, or preoperative risk level. The left internal mammary artery was mobilized from the fifth costal cartilage to the subclavian artery in all patients. The anastomoses were done with a beating heart in the MIDCABG group and with cardioplegic arrest in the sternotomy group. RESULTS There were no operative deaths in either group. The MIDCABG patients had a lower transfusion incidence (10/60 [17%] versus 22/55 [40%]; p< or =0.02) and a shorter postoperative intubation time (2.1+/-4.2 versus 12.6+/-9 hours; p< or =0.0001). One patient in each group was reexplored for bleeding. Three sternotomy patients (3/55, 5%) required ventilatory support for greater than 48 hours, but no MIDCABG patient was ventilated for more than 24 hours. Median postoperative length of stay was 4 days for MIDCABG and 7 days for sternotomy. Estimated hospital costs were $11,200+/-3100 for MIDCABG and $15,600+/-4200 for CABG (p < 0.001). The reduced morbidity and cost of MIDCABG was found mostly in high-risk patients. At 6-month follow-up, 5 MIDCABG patients (5/60, 8%) had evidence of recurrent ischemia involving the left anterior descending artery, primarily the result of anastomotic stricture. CONCLUSIONS This analysis shows that MIDCABG reduces the initial morbidity and cost of coronary bypass, but some patients require subsequent reintervention. Long-term follow-up is needed before MIDCABG can be judged better than traditional bypass, but the initial results are promising, especially in high-risk patients.
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Affiliation(s)
- J A Magovern
- Division of Thoracic Surgery, Allegheny University Hospitals, Allegheny General, and Allegheny University of the Health Sciences, Pittsburgh, PA 15212, USA
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Hearne SE, Davidson CJ, Zidar JP, Phillips HR, Stack RS, Sketch MH. Internal mammary artery graft angioplasty: acute and long-term outcome. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 44:153-6; discussion 157-8. [PMID: 9637437 DOI: 10.1002/(sici)1097-0304(199806)44:2<153::aid-ccd6>3.0.co;2-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Secondary to the low attrition rate of internal mammary artery grafts, limited data are available on the clinical and angiographic outcome of patients who have undergone balloon angioplasty of an internal mammary artery stenosis. This study examined a consecutive series of 68 patients who underwent balloon angioplasty of an internal mammary artery graft over a 9-year period. Procedural success was achieved in 60 of 68 (88%) patients. The primary reason for procedural failure was extreme vessel tortuosity. There were no major in-hospital complications. Angiographic follow-up was obtained in 78% of the patients with an angiographic restenosis rate of 19%. The overall event-free survival in patients with an initially successful procedure was 92%. In conclusion, internal mammary artery balloon angioplasty has both an excellent initial success rate as well as a low incidence of restenosis and repeat target lesion revascularization.
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Affiliation(s)
- S E Hearne
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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Ishizaka N, Ishizaka Y, Ikari Y, Isshiki T, Tamura T, Suma H, Yamaguchi T. Initial and subsequent angiographic outcome of percutaneous transluminal angioplasty performed on internal mammary artery grafts. Heart 1995; 74:615-9. [PMID: 8541165 PMCID: PMC484116 DOI: 10.1136/hrt.74.6.615] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To estimate the initial outcome and incidence of restenosis of angioplasty of internal mammary artery grafts in a retrospective study. METHODS The study population consisted of 46 patients (48 lesions) who underwent first balloon angioplasty within the internal mammary artery graft. Most (37/48) were at the distal anastomosis. A few (8/48) were in the graft body. Six patients with the evidence of angiographic restenosis underwent a second angioplasty. RESULTS The success rate and the restenosis rate of the first angioplasty was 73% and 30% respectively. Of the 34 patients (35 lesions) with a successful first angioplasty, 30 underwent follow up angiography with a restenosis rate of 30% (9/30). A second angioplasty was performed on six of the nine restenotic lesions, with a success rate of 83% and no restenoses. The percent diameter stenosis of the recipient native coronary artery was significantly greater in the restenosis group, at 75 (SD 27)% v 89 (17)%, p < 0.05. CONCLUSIONS First angioplasty of 46 patients (48 lesions) within an internal mammary artery graft was performed with a success rate of 73% and a restenosis rate of 30% (follow up rate of 88%). The extent of the stenosis of the recipient native coronary artery may affect the restenosis rate.
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Affiliation(s)
- N Ishizaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
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Hadjimiltiades S, Gourassas J, Louridas G, Tsifodimos D. Stenting the distal anastomotic site of the left internal mammary artery graft: a case report. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1994; 32:157-61. [PMID: 7914832 DOI: 10.1002/ccd.1810320211] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The major problem associated with the long-term patency of the internal mammary artery graft is the early occurrence of stenosis usually at its distal anastomotic site; its management by balloon angioplasty has been associated with a high success rate. We report the case of an unsuccessful balloon angioplasty of an anastomotic stenosis of a left internal mammary artery graft that was successfully managed by stenting with one-half of a Palmaz-Schatz stent.
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