PCI in the left internal mammary artery: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
{{SI}} | {{SI}} | ||
{{CMG}} | {{CMG}} | ||
==Overview== | |||
Percutaneous coronary intervention in the [[left internal mammary artery]] poses several challenges for the interventional cardiologist. A short guide catheter must be used because the distance to the lesion may be quite long, and all efforts must be made to preserve the workable length of the balloon. There is often poor guide catheter support to engage the internal mammary artery. Finally, the [[internal memory artery]] is susceptible to [[coronary spasm|spas]]m confusing the the diagnosis and treatment of the disease. | |||
The left internal mammary artery can develop disease at 4 sites: | ==Pathophysiology== | ||
The [[left internal mammary artery]] can develop disease at 4 separate sites: | |||
#At the ostium. This should not be confused for spasm. The ostium of the IMA is prone to spasm and aggressive therapy with nitrates is recommended to minimize the possibility that the lesion is due to spasm rather than fixed obstructive dz. | #At the ostium. This should not be confused for spasm. The ostium of the IMA is prone to spasm and aggressive therapy with nitrates is recommended to minimize the possibility that the lesion is due to spasm rather than fixed obstructive dz. | ||
| Line 13: | Line 14: | ||
#An intervention is sometimes performed in the native LAD distal to the anastomosis | #An intervention is sometimes performed in the native LAD distal to the anastomosis | ||
==Technical Considerations== | |||
A short | *A short guiding catheter should be used (a 100 cm guide). Otherwise the balloon will not reach distal parts of the left internal mammary artery. | ||
*[[Coronary spasm]] may develop at the [[ostium]] during the procedure which can be confused wiht a [[dissection]]. Nitrates and repositioning of the wire to minimize wire bias should be performed before stenting the ostium. | |||
The approach to kinks in an artery such as the IMA is discussed [[myocardial bridge|elsewhere]]. | *The approach to kinks in an artery such as the IMA is discussed [[myocardial bridge|elsewhere]]. | ||
==References== | |||
{{Reflist|2}} | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Up-To-Date]] | |||
[[Category: Up-To-Date Cardiology]] | |||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 16:11, 25 October 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Percutaneous coronary intervention in the left internal mammary artery poses several challenges for the interventional cardiologist. A short guide catheter must be used because the distance to the lesion may be quite long, and all efforts must be made to preserve the workable length of the balloon. There is often poor guide catheter support to engage the internal mammary artery. Finally, the internal memory artery is susceptible to spasm confusing the the diagnosis and treatment of the disease.
Pathophysiology
The left internal mammary artery can develop disease at 4 separate sites:
- At the ostium. This should not be confused for spasm. The ostium of the IMA is prone to spasm and aggressive therapy with nitrates is recommended to minimize the possibility that the lesion is due to spasm rather than fixed obstructive dz.
- At the site of a kink in the IMA.
- In the body of the IMA (somewhat rare)
- At the anastomosis of the IMA with the LAD
- An intervention is sometimes performed in the native LAD distal to the anastomosis
Technical Considerations
- A short guiding catheter should be used (a 100 cm guide). Otherwise the balloon will not reach distal parts of the left internal mammary artery.
- Coronary spasm may develop at the ostium during the procedure which can be confused wiht a dissection. Nitrates and repositioning of the wire to minimize wire bias should be performed before stenting the ostium.
- The approach to kinks in an artery such as the IMA is discussed elsewhere.