PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY OF INTERNAL MAMMARY ARTERIES INPATIENTS WITH REST ANGINA

Angioplasty of the internal mammary artery (IMA) bypass graft has been shown to be a safe and effective revascularization procedure. However , angiographic and long term clinical outcomes in the high-risk group of patients presenting with rest angina has not been well documented. We report the results of IMA angioplasty in 20 patients with rest angi na out of 614 (3.2%) who received a left IMA graft at our institution between April 1987 and September 1994. All patients were admitted with rest angina, 12 patients demonstrated persistent ischemia despite med ical therapy, two patients were in heart failure, and one patient was in cardiogenic shock. Balloon angioplasty was successful in 15 of 20 p atients (75%). Failed angioplasty was associated with either severe IM A tortuouslty (three patients) or inability to cross the anastomotic s tenosis with the guide wire (two patients). Each of these five patient s required angioplasty of either the native left anterior descending a rtery or other saphenous vein grafts for clinical stabilization. No pa tient suffered a major complication (myocardial infarction, emergent c oronary bypass surgery, death). Clinical follow-up was obtained in all 20 patients (6 months, 7 years, mean 27 months). Twelve patients (60% ) were asymptomatic or had stable angina at follow-up, and 8 returned with anginal symptoms. Four patients required repeat angioplasty for d isease in other vessels, two were treated medically for angina, one un derwent repeat CABG, and cardiac transplantation was performed in one patient for refractory heart failure. Angiographic follow up was obtai ned In 10/15 (66%) successful angioplasty patients, and only one patie nt demonstrated restenosis at the treated site (10%). During follow up one patient developed an IMA stenosis at a previous dissection site i n the body of the graft that was treated with angioplasty. These resul ts suggest that IMA angioplasty in patients with rest angina is associ ated with excellent long term patency and clinical efficacy, as well a s low procedural risk. (C) 1996 Wiley-Liss, Inc.