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 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.