PCI in the left internal mammary artery
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The left internal mammary artery can develop disease at 4 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
Interventional approach: A short guide should be used (a 100 cm guide). Otherwise the balloon will not reach the ostium. Spasm may develop at the ostium during the procedure which can be confused for 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.