Internal mammary artery steal syndrome secondary to a para-IMA after coronary artery bypass graft: a case report

The use of the internal mammary artery (IMA) in coronary artery bypass graft(CABG) for myocardial revascularization is gaining popularity in routine practice, especially when the target vessel is the left anterior descending artery (LAD). Occasionally, IMA hypoperfusion occurs when there is inadequate flow through the IMA graft to the LAD artery due to the exist of lateral branches.4,5 The graft hypoperfusion can occur both acutely and chronically resulting in malperfusion syndrome and dysfunctional graft with persistent ischemia in the region of supply. Here we report a recent case who had recurrent LAD ischemia six days after two-vessel coronary artery bypass grafting(CABG) due to internal mammary artery steal syndrome. Patient was successfully treated with transcutaneous steel coil embolization to occlude the anomalous vessel. This resulted in improved perfusion in LAD and symptomatic improvement.