PMC4008282_01
Left anterior oblique view of the left coronary artery. A JL4 catheter is seen engaging the left coronary artery. The ostial left main is tapered and has a 70% stenosis.
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fig1
Subsequent left heart catheterization (LHC) showed 70% ostial left main stenosis (Figure 1), 60% left anterior descending artery (LAD) stenosis, and complete occlusion of the mid circumflex artery with filling via right to left collaterals.
This is an angiogram of the left internal mammary artery as it anastomoses to a cardiac vein. Contrast fills the coronary sinus as it traverses the posterior atrioventricular groove.
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fig2
Angiography of the LIMA demonstrated that it was anastomosed to a cardiac vein with resultant flow into the coronary sinus (Figure 2).
Right anterior oblique view of the left coronary artery following left main and LAD intervention. The left main is no longer tapered and the contrast effluxes out of the left main into the left coronary cusp of the aortic valve.
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fig3
There was no residual stenosis (Figure 3).
Angiogram of the deployment of the coils in the distal left internal mammary artery. The catheter is accessing the LIMA via the left subclavian artery.
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fig4
Subsequently, eight 3 mm stainless steel coils were deployed in the distal portion of the LIMA just proximal to the anastomosis with the cardiac vein with resultant occlusion of the LIMA (Figure 4). 