Percutaneous Transluminal Angioplasty to Left Internal Mammary Artery Grafts: Immediate and Long-term Clinical Outcomes

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 LIMA 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