Successful percutaneous treatment of a catastrophic left internal mammary artery graft avulsion occurring 4 weeks post-coronary artery bypass grafting surgery: a case report

Abstract

Background Avulsion of the left internal mammary artery (LIMA) graft near the anastomosis to the left anterior descending artery (LAD) artery post-coronary artery bypass grafting (CABG) is a rare but potentially catastrophic complication which can result in sudden ischaemia, haemodynamic compromise and life-threatening bleeding into the pericardium. Case summary We report a case of a spontaneous LIMA graft avulsion at the site of the anastomosis to the LAD artery, which occurred 4 weeks post-conventional CABG surgery and resulted in anterior myocardial infarction (MI), cardiac tamponade and cardiogenic shock. This life-threatening event was treated by deploying a covered stent in the LAD artery and by coiling the dehisced LIMA graft. Discussion To our knowledge, this is the first report of late LIMA graft avulsion that has been uniquely and successfully treated by percutaneous coronary intervention.