case_images: PMC10782429_01
case_images: Diagnostic Coronary Angiogram of the Native Coronary Arteries and Radial Jump Grafts from the Left Internal Mammary Artery
case_images: icr-18-e27-g001.jpg
case_images: PMC10782429_01_icr-18-e27-g001.jpg
case_images: fig1
case_images: The LAD was occluded after a large first septal artery and the circumflex (Cx) was a small vessel with a patent distal atrioventricular Cx but occluded obtuse marginal branches (Figure 1).
case_images: Left Internal Mammary Artery Appearance after Inlet of Dissection Sealed with Ostial Drug-eluting Stent
case_images: icr-18-e27-g002.jpg
case_images: PMC10782429_01_icr-18-e27-g002.jpg
case_images: fig2
case_images: The inlet of the suspected dissection site, i.e. the ostium of the LIMA, was secured by placing a 4 x 12 mm Onyx DES but despite this, antegrade flow was not achieved, indicating that the dissection had propagated further into the LIMA beyond the distal edge of the stent (Figure 2).
case_images: Left Internal Mammary Artery Appearance after Entire Dissection Length Sealed with Four Drug-eluting Stents
case_images: icr-18-e27-g003.jpg
case_images: PMC10782429_01_icr-18-e27-g003.jpg
case_images: fig3
case_images: A standard injection through the guide catheter then revealed restoration of brisk flow and well-sized stents, with the stent material covering the LIMA ostium and extending around 1 mm back into the left subclavian artery (Figure 3).
case_images: Final Appearance of Radial Artery Graft Bifurcation with Loss of Flow to First Obtuse Marginal but Brisk Flow to Right Posterior Descending Artery
case_images: icr-18-e27-g004.jpg
case_images: PMC10782429_01_icr-18-e27-g004.jpg
case_images: fig4
case_images: It was noted that there was loss of flow into the radial jump supplying the OM1 graft, but as the patient was pain free and stable at this point, it was decided to manage this conservatively (Figure 4).