Multi-detector Row CT Evaluation of Coronary Artery Bypass Graft Using Reverse Left Internal Mammary Artery: a case report

Reprint requests to: Dr. I-Chen Tsai Department of Radiology, Taichung Veterans General Hospital. No. 160, Sec. 3, Taichung Harbor Road, Taichung 407, Taiwan, R.O.C. Many studies have shown that multi-detector row CT (MDCT) can accurately evaluate coronary artery bypass grafts. When compared with cardiac catheterization, the diagnostic accuracy of MDCT for coronary artery bypass graft is promising. However, to our knowledge, there has been no report showing if the clinical applicability of MDCT can surpass cardiac catheterization in certain circumstances. We will present a case, with iatrogenic injury of proximal left internal mammary artery (LIMA), received a composite arterial graft using reverse LIMA flow and radial artery to supply all three coronary territories. The reverse LIMA f low was from left inferior epigastric artery and two intercostal arteries, which is extremely difficult, if not impossible, to allow simultaneous catheterization and contrast injection. In this case, MDCT demonstrated its powerful capability in coronary artery bypass grafts with complex anatomy, resolving the limitations of the clinical applicability of cardiac catheterization.