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CASE REPORT
separate LIMA catheter or using tapered soft tip catheter.8 Another suggested approach includes the use of balloon-tipped 9 Regarding the arterial access, left radial approach utilizing a LIMA catheter was reported to offer a safe and appropriate alternative that may alleviate many of the challenges associated with LIMA.6,10
However, whether these precautions are really effective in preventing LIMA dissection is unclear. In a retrospective review of single center procedure log showed that among 541 LIMA angiography procedures, there was only one LIMA dissection. The complication occurred in a case where a LIMA catheter
was used. Literature review showed only ten reported cases of LIMA dissection, which is probably underestimating the real prevalence of the complications.3-5,7,8,11-15 LIMA dissection was 7,12-15 In the 3,5,11 Successful percutaneous intervention was performed in seven of the nine cases using multiple stents.3,5,11-15 One case was treated with one stent covering only the dissected LIMA segment. Unfortunately, the patient developed further dissection in ten days requiring CABG.5 Another case was treated primarily with re-do CABG other coronary territories.7 to the subclavian artery. Using a dual balloon angioplasty to treat the remnant ostial LIMA and subclavian dissection resulted in good clinical and angiographic result and avoidance of potential surgical intervention.
CONCLUSION
LIMA dissection is a dreadful complication that can lead to severe complications if not managed urgently. Trans-catheter management with stenting is the preferred management for IMA dissection. Dual balloon angioplasty system may offer an advantage in proximal dissection sites by completely sealing the both the LIMA graft and subclavian artery.
FIGURE 5
Final angiographic image of LIMA after Flash dual balloon angioplasty.
9. Sharifi M, Lauer J, Pompili VJ, Dillon JC. Arteriography of the left internal mammary artery graft utilizing a balloon-tipped floatation catheter: an alternative approach. J Invasive Cardiol. 1999;11:682-684.
10. Mann T, Cubeddu G, Schneider J, Arrowood M. Left internal mammary artery intervention: the left radial approach with a new guide catheter. J Invasive Cardiol. 2000;12:298-302.
11.Moon CH, Nanavati VI. Multi-stent approach in the treatment of acute dissection of the left internal mammary artery. J Invasive Cardiol. 1999;11:248-250.
12.Ziaee A, Puri S, Kern MJ. Stenting for spontaneous left internal mammary artery dissection: a case report. Catheter Cardiovasc Interv. 2003;60:389-391. 13.Wong P, Rubenstein M, Inglessis I, Pomerantsev E, Ferrell M, Leinbach R. Spontaneous spiral dissection of a LIMA-LAD bypass graft: a case report.
J Interv Cardiol. 2004;17:211-213.
14. Suresh V, Evans S. Successful stenting of stenotic lesion and spontaneous dissection of left internal mammary artery graft. Heart. 2007;93:44.
15. Claessens P, Willaert W, Claessens M, et al. Symptomatic atraumatic dissection of a left internal mammary artery graft five years after coronary artery bypass graft surgery. Can J Cardiol. 2002;18:759-761.
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