Left Internal Mammary Artery Dissection: Use of Dual Balloon Angioplasty in Treatment of Ostial Dissection Involving Subclavian Artery.

The left internal mammary artery (LIMA) is the preferred arterial graft to be used for the left anterior descending (LAD) artery for coronary artery bypass graft (CABG) due to high graft patency rate. LIMA dissection is a rare, but dreadful complication of graft angiography and may lead to serious complications including death, myocardial infarction (MI), and re-do CABG. Transcatheter management of LIMA dissection involves multiple stenting. However, this may leave a dissection flap at the ostium of the LIMA that may extend to the left subclavian artery jeopardizing flow to the left arm and vertebral artery. We present a case of LIMA dissection where a dual balloon angioplasty was used for the first time offering better "sealing" of the dissection flap at the level of the ostium of the LIMA graft/subclavian artery.