PCI in the left internal mammary artery

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Percutaneous coronary intervention Microchapters


Patient Information


Risk Stratification and Benefits of PCI

Preparation of the Patient for PCI

Equipment Used During PCI

Pharmacotherapy to Support PCI

Vascular Closure Devices

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post-PCI Management

Risk Reduction After PCI

Post-PCI follow up

Hybrid coronary revascularization

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PCI Complications

Factors Associated with Complications
Vessel Perforation
Distal Embolization
Coronary Vasospasm
Abrupt Closure
Access Site Complications
Peri-procedure Bleeding
Renal Failure
Late Acquired Stent Malapposition
Loss of Side Branch
Multiple Complications

PCI in Specific Patients

Cardiogenic Shock
Left Main Coronary Artery Disease
Refractory Ventricular Arrhythmia
Severely Depressed Ventricular Function
Sole Remaining Conduit
Unprotected Left Main Patient
Adjuncts for High Risk PCI

PCI in Specific Lesion Types

Classification of the Lesion
The Calcified Lesion
The Ostial Lesion
The Angulated or Tortuous Lesion
The Bifurcation Lesion
The Long Lesion
The Bridge Lesion
The Chronic Total Occlusion
The Left Internal Mammary Artery
Multivessel Disease
Distal Anastomotic Lesions
Left Main Intervention
The Thrombotic Lesion

PCI in the left internal mammary artery On the Web

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Directions to Hospitals Treating Percutaneous coronary intervention

Risk calculators and risk factors for PCI in the left internal mammary artery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Percutaneous coronary intervention in the left internal mammary artery poses several challenges for the interventional cardiologist. A short guide catheter must be used because the distance to the lesion may be quite long, and all efforts must be made to preserve the workable length of the balloon. There is often poor guide catheter support to engage the internal mammary artery. Finally, the internal mammary artery is susceptible to spasm confusing the the diagnosis and treatment of the disease.

PCI in The Left Internal Mammary Artery


The left internal mammary artery can develop disease at 4 separate sites:

  1. At the ostium. This should not be confused for spasm. The ostium of the IMA is prone to spasm and aggressive therapy with nitrates is recommended to minimize the possibility that the lesion is due to spasm rather than fixed obstructive disease.
  2. At the site of a kink in the IMA.
  3. In the body of the IMA (somewhat rare)
  4. At the anastomosis of the IMA with the LAD
  5. An intervention is sometimes performed in the native LAD distal to the anastomosis

Technical Considerations


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