Percutaneous Revascularization of Chronic Total Occlusion of LIMA to LAD Anastomosis

The left internal mammary artery (LIMA) is widely used during coronary artery bypass grafting (CABG) and considered to be most reliable and long term patent coronary graft. However, cases of LIMA-to-LAD graft failure occur and dramatically impair clinical status and life expectancy of patients. Stenotic lesions of LIMA grafts are easily repaired by percutaneous techniques. But totally occluded grafts generally indicate for necessity of redo open heart surgery which is associated with increased morbidity and mortality. In this report we present clinical case of the 61 y.o. patient who had undergone CABG and mitral valve replacement 7 years ago and LIMA graft anastomosis angioplasty 2 months afterwards. The patient presented significant angina and heart failure symptoms and during angiography the chronic total occlusion of the LIMA graft anastomosis site was revealed. We successfully performed transluminal revascularization and stenting of the LIMA-to-LAD anastomosis with the drug eluting coronary stent. The patient was discharged 3 days after the procedure and remained angina free with significant improvement of heart function during 4 month follow-up.