Percutaneous transluminal angioplasty of ostial lesions of internal mammary artery grafts

The internal mammary artery (IMA) is currently the best graft for coronary bypass surgery and is therefore preferentially anastomosed to major arterie s, usually the left anterior descending (LAD) artery. This graft may develo p a stenosis, most often at the distal anastomosis. Ostial stenoses are rar e and their pathophysiology uncertain. While angioplasty of distal anastomo tic lesions provides adequate results, the very small number of published c ases of angioplasty of ostial lesions explains the rack of knowledge on res ults of this type of procedure. The authors report six procedures of this t ype on five patients, including two with stenting. The primary success rate was 100%, with only one hospital complication in the form of pulmonary ede ma. Mean follow-up for 35 months revealed one sudden death due to probable restenosis, another death 3 years after angioplasty from rapid fatal shock without complementary investigation, and one case of unstable angina second ary to intrastent restenosis. These results suggest that this type of angio plasty is technically feasible with low risk, and that the restenosis rate seems relatively high, potentially presenting as sudden death, in the same way as unprotected dilatation of the native left main artery. A very close clinical follow-up of these patients is therefore necessary, with angiograp hic control in case of suspected ischemia. (C) 2001 Wiley-Liss, Inc.