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  • Title: Percutaneous transluminal angioplasty to left internal mammary artery grafts: immediate and long-term clinical outcomes.
    Author: Hung WC, Wu CJ, Yip HK, Fang CY, Hang CL, Chen SM, Chen MC, Yu TH, Wang CP, Hsieh YK.
    Journal: Chang Gung Med J; 2007; 30(3):235-41. PubMed ID: 17760274.
    Abstract:
    BACKGROUND: Increasing usage of the left internal mammary artery (LIMA) as the graft of choice in coronary artery bypass surgery has led to increased incidence of LIMA graft stenosis. METHODS: Thirteen patients with LIMA graft stenosis were identified from a review of our institutional database, with intervention approach either from the femoral (n = 6) or radial artery (n = 7). There were no LIIMA orifice lesions and all patients presented with anastomosis site stenoses, except one individual who had combined LIMA shaft stenosis. Clinical outcomes were assessed. RESULTS: The procedural success rate was 92% (12/13). Conventional balloon dilation was performed in seven cases and stenting in five. Two patients developed LIMA body dissection during the procedure, with one requiring bail-out stenting and the other prolonged balloon inflation. The in-hospital major adverse cardiac events included 1 non-Q wave myocardial infarction (7.7%) but no deaths, emergency coronary artery bypass surgery or target lesion revascularization. In the one failure case, the patient died 1 month later at home. Angiographic follow-up of ten patients (83%) revealed a restenosis rate of 20% (2/10). The mean clinical follow-up duration was 34.5 +/- 20.9 months. One patient expired 32 months later due to acute stroke with sepsis. CONCLUSION: Percutaneous transluminal intervention of LIMA grafts can be performed safely from either the femoral or radial approach. High procedure success and low complication rates are achievable by an experienced cardiologist; long-term clinical results were excellent in our patients. It can be considered as an alternative therapeutic method for a stenosed LIMA graft.
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