Effective percutaneous treatment of a subacute left internal mammary artery perforation and pseudoaneurysm after coronary artery bypass grafting: a case report.

Abstract

Background: Perforation of the left internal mammary artery (LIMA) graft is a rare but severe complication of coronary artery bypass grafting (CABG).

Case summary: A 75-year-old Caucasian man with hypertension, diabetes, dyslipidaemia, and a history of SARS-CoV-2 presented with exertional dyspnoea. After CABG with a Y-graft anastomosis using the right internal mammary artery, he experienced severe chest pain. A transthoracic echocardiogram revealed a haemopericardium. A computed tomography scan identified a LIMA pseudoaneurysm in contact with the haemopericardium near the anterior and anterolateral left ventricle walls. Angiography confirmed the LIMA pseudoaneurysm and left anterior descending artery (LAD) graft occlusion. The LIMA pseudoaneurysm was treated with a covered stent, and the LAD was revascularized with rotational atherectomy and drug-eluting stent. At the three-year follow-up, the patient remained asymptomatic, and the scan performed at the two-year mark indicated patent grafts with no signs of restenosis.

Discussion: This case illustrates the successful percutaneous management of a rare LIMA pseudoaneurysm, preventing high-risk reoperation. It also highlights the importance of multimodal imaging and interventional strategies in managing complex post-CABG complications.