Transbrachial coil occlusion of the large branch of an internal mammary artery coronary graft

Percutaneous transbrachial insertion of two complex coils into the intercostal branch of the left internal mammary artery resulted in the relief of severe angina in a 45-year-old man who had coronary artery bypass surgery 2 years before. The diagnosis of coronary artery steal was made clinically. This case illustrates the importance of recognizing coronary steal in patients who redevelop angina after coronary artery surgery with the use of an incompletely prepared left internal mammary artery as a conduit. Brachial or radial artery should be preferred to reach left internal mammary artery (LIMA) for cannulation easily. The preoperative angiographic imaging of LIMA is important to detect the side branches and their sizes. The patient was treated without the need for further surgery.