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Left Internal Mammary Artery Dissection:
Use of Dual Balloon Angioplasty in Treatment of Ostial Dissection Involving Subclavian Artery
Zaher Fanari, MD; Jhapat Thapa, MBBS; Subba R. Vanga, MBBS, MS; Wasif Qureshi, MD
The left internal mammary artery (LIMA) is the preferred arterial graft to be used for the left anterior descending (LAD) artery for coronary artery bypass graft (CABG) due to high graft patency rate.
LIMA dissection is a rare, but dreadful complication of graft angiography and may lead to serious complications including death, myocardial infarction (MI), and re-do CABG. Transcatheter management of LIMA dissection involves multiple stenting. However, this may leave a dissection flap at the ostium of the LIMA that may extend to the left subclavian artery jeopardizing flow to the left arm and vertebral artery. We present a case of LIMA dissection where a dual balloon angioplasty was used for the
first time offering better “sealing” of the dissection flap at the level of the ostium of the LIMA graft/ subclavian artery.
Key Words: Left internal mammary artery, complication, percutaneous coronary intervention, dual balloon angioplasty
BackgroundThe left internal mammary artery (LIMA) is a preferred
arterial graft for coronary artery bypass graft surgery due to high graft patency rate. The early patency rate of LIMA graft is 99 percent.1 slightly lower at 10 years.2 The LIMA graft dissection is a rare, but dreadful complication of graft angiography. The available literature on incidence of LIMA dissection and its treatment strategy is limited probably due to under reporting.3
Most of the LIMA dissection cases are managed with angioplasty and multiple stenting.3 However, the dissection may extend backward through the ostium to the left subclavian artery 4,5 The
dual balloon angioplasty may offer better management to “seal” therefore prevent the dissection from extending to the subclavian artery. We present a case of catheter-induced LIMA dissection and its successful treatment with multiple stenting using dual balloon angioplasty system at the level of the ostium.
FIGURE 1
LIMA angiography revealing severe in-stent restenosis of distal LAD.
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Del Med J | June 2015
| Vol. 87
| No. 6
Abstract
