Key result
Balloon trial occlusion with Doppler wire confirms physiologically significant LIMA steal to guide embolization.
Why the study?
Unligated side branches of the LIMA graft causing coronary steal and angina remain controversial despite reports of symptom relief after embolization.
Can trial occlusion with selective balloon inflation and intracoronary Doppler wire confirm physiologic significant steal in a LIMA graft with an unligated side branch?
Case Report (n=1)
Can trial occlusion with selective balloon inflation and intracoronary Doppler wire confirm physiologic significant steal in a LIMA graft with an unligated side branch?
Intracoronary Doppler with adenosine during trial balloon occlusion can physiologically confirm coronary steal from an unligated LIMA side branch, guiding the decision for coil embolization.
Supports Doppler confirmation of steal during balloon occlusion in select LIMA cases; hypothesis-generating and requires validation before broader adoption.
Unligated side branches of the left internal mammary artery (LIMA) have been described in the literature as a cause of coronary steal resulting in angina. Despite a number of studies reporting successful side branch embolization to relieve symptoms, this phenomenon remains controversial. Hemodynamic evidence of coronary steal using angiographic and intravascular Doppler techniques has been supported by some and rejected by others. In this case study using an intracoronary Doppler wire with adenosine, we demonstrate that a trial occlusion of the LIMA thoracic side branch with selective balloon inflation can confirm physiologic significant steal and whether coil embolization of the side branch is indicated.
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Sawaya et al. (2016) conducted a case report in Refractory angina due to LIMA to LAD coronary steal (n=1). Trial occlusion of the LIMA thoracic side branch with selective balloon inflation using an intracoronary Doppler wire with adenosine was evaluated on Confirmation of physiologic significant steal and indication for coil embolization. Trial occlusion of the LIMA thoracic side branch with selective balloon inflation using an intracoronary Doppler wire with adenosine can confirm physiologic significant steal and indicate embolization.
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