Application of percutaneous transluminal coronary angioplasty to the internal mammary artery graft

Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.

Between June 1982 and August 1987, 45 patients underwent percutaneous transluminal coronary angioplasty within the internal mammary artery graft (group 1) or had coronary angioplasty performed beyond the graft insertion with the internal mammary artery used as a conduit (group 2). Previous coronary artery bypass surgery was performed at a mean of 29.8 months (range 2 to 199) in group 1 and 51.3 months (range 2 to 134) in group 2. Sixteen (62%) of 26 patients in group 1 and 17 (71%) of 24 patients in group 2 had multivessel angioplasty; multilesion angioplasty was performed in 20 patients (77%) in group 1 and in 19 patients (79%) in group 2. Within group 1, 12 (37.5%) of 32 lesions were in the body of the internal mammary artery graft and 20 lesions (62.5%) occurred at the distal anastomosis. Angioplasty was successful in 30 (94%) of 32 attempts in group 1 and in 25 (96%) of 26 attempts in group 2. Procedure-related complications were limited to emergent bypass surgery in one patient in group 2. At a mean follow-up period of 12.7 months in group 1 and 18.2 months in group 2, 39 (90%) of the 45 patients had no or only mild angina. There were two late cardiac deaths (mortality rate 4.9%) in the 41 patients with successful angioplasty. The results of this study demonstrate that percutaneous transluminal coronary angioplasty of internal mammary artery grafts combined with multilesion angioplasty is technically feasible, can be performed with a high primary success rate and a low incidence of complications and achieves sustained clinical improvement in the majority of patients.

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