case_images: PMC4769740_01
case_images: Patent hypoplastic LIMA with large thoracic side branch.
case_images: CRIC2016-3175798.001.jpg
case_images: PMC4769740_01_CRIC2016-3175798.001.jpg
case_images: fig1
case_images: His grafts showed a patent SVG to first diagonal and a small hypoplastic patent LIMA to LAD (Figure 1).
case_images: Coronary flow reserve (CFR) tracing during intravenous adenosine infusion prior to balloon directed occlusion revealing a value of 3.4 after IV adenosine 140 mcg/kg/min.
case_images: CRIC2016-3175798.002.jpg
case_images: PMC4769740_01_CRIC2016-3175798.002.jpg
case_images: fig2
case_images: CA) was advanced into the mid-portion of LIMA distal to the first thoracic branch collateral. CFR after systemic intravenous (IV) adenosine injection (140 mcg/kg/min) was measured, and a baseline value of 3.4 was recorded (Figure 2).
case_images: The LIMA was engaged with a 6-French IMA guide catheter. The Doppler wire was then advanced into the mid-portion of the LIMA distal to the first thoracic branch collateral with balloon occlusion of side branch.
case_images: CRIC2016-3175798.003.jpg
case_images: PMC4769740_01_CRIC2016-3175798.003.jpg
case_images: fig3
case_images: The balloon was inflated within the thoracic side branch inducing complete occlusion of flow (Figure 3).
case_images: Coronary flow reserve (CFR) tracing during 140 mcg/kg/min intravenous adenosine infusion following side branch balloon occlusion revealing a value of 5.3.
case_images: CRIC2016-3175798.004.jpg
case_images: PMC4769740_01_CRIC2016-3175798.004.jpg
case_images: fig4
case_images: The discrepancy in CFR measurement from the time before and after side branch occlusion was consistent with significant coronary steal through this branch from the left internal mammary artery (Figure 4).
case_images: Angiogram of the LIMA showing successful microembolization of the thoracic side branch after placement of 4 microcoils with concomitant significant increase in LIMA size.
case_images: CRIC2016-3175798.005.jpg
case_images: PMC4769740_01_CRIC2016-3175798.005.jpg
case_images: fig5
case_images: Once complete embolization was documented, the microdelivery catheter was removed and final images of the LIMA demonstrated significant increase in flow and caliber of the vessel (Figure 5).