Coronary Steal by IMA Bypass Graft Side-branches: a Novel Therapeutic Use of a New Detachable Embolization Coil

Coronary artery steal syndromes following coronary artery bypass grafting (CAB) may occur as a result of the presence of large side-branches arising from the internal mammary artery (IMA). We report the first successful deployment of a new detachable vascular embolization coil device to occlude the IMA side-branches in two patients. Optimal positioning is easily obtained with the unique operator-controlled, safety-release protected mechanism of this device. Complete retraction is possible, with safe and efficient removal of the coil even after deployment. This feature was appreciated during one procedure in which the initially selected coil was found to be oversized, requiring immediate removal. Acute thrombo-occlusion of the IMA side-branches in both patients was observed. We conclude that IMA bypass graft side-branches causing coronary steal can be safely and effectively occluded using this new technique. However, due to observed delayed partial recanalization noted on distant follow-up angiography, we recommend placement of multiple coils at the time of initial embolization.