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Figure 5 Patient with flow competition. (Upper panels) Flow velocity in the left internal mammary artery (LIMA) shows a higher systolic than diastolic component and a markedly abnormal coronary flow velocity reserve (CFR). (Middle panels) CFR, measured in the distal left anterior descending coronary artery (LAD), was normal. (Lower panels) Coronary angiography showed that the LIMA was proximally patent, but contrast material stopped at the joining tract. There was no flow limiting stenosis in the distal LAD after the anastomosis.