Case report
Ischemia induced by coronary steal through a patent mammary artery side branch: A role for embolization
Isquemia induzida por roubo coronário através de um ramo patente da artéria mamária interna: um papel para a embolização
Lido
10880
Vezesque se leu este artigo
2661
Total PDF
8219
Total HTML
Compartilhar estatísticas
array:24 [ "pii" => "S0870255113001170" "issn" => "08702551" "doi" => "10.1016/j.repc.2012.09.011" "estado" => "S300" "fechaPublicacion" => "2013-06-01" "aid" => "288" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2013;32:531-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6834 "formatos" => array:3 [ "EPUB" => 217 "HTML" => 5560 "PDF" => 1057 ] ] "itemSiguiente" => array:20 [ "pii" => "S0870255113000310" "issn" => "08702551" "doi" => "10.1016/j.repc.2012.08.013" "estado" => "S300" "fechaPublicacion" => "2013-06-01" "aid" => "247" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2013;32:535-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7812 "formatos" => array:3 [ "EPUB" => 184 "HTML" => 6330 "PDF" => 1298 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso Clínico</span>" "titulo" => "Um caso de pericardite constritiva e aneurisma da aorta torácica: abordagem terapêutica híbrida" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "535" "paginaFinal" => "539" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "A case of constrictive pericarditis and thoracic aortic aneurysm: A hybrid therapeutic approach" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1310 "Ancho" => 987 "Tamanyo" => 174063 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ecocardiograma transtorácico.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A – Pericárdio espessado e ecogénico.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">B – Variabilidade respiratória da amplitude da onda E.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maria Salomé Carvalho, Pedro Jerónimo de Sousa, Pedro de Araújo Gonçalves, Hélder Dores, Miguel Abecasis, Manuel Almeida, Miguel Mendes" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Maria Salomé" "apellidos" => "Carvalho" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Jerónimo de Sousa" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "de Araújo Gonçalves" ] 3 => array:2 [ "nombre" => "Hélder" "apellidos" => "Dores" ] 4 => array:2 [ "nombre" => "Miguel" "apellidos" => "Abecasis" ] 5 => array:2 [ "nombre" => "Manuel" "apellidos" => "Almeida" ] 6 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204913001116" "doi" => "10.1016/j.repce.2013.06.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913001116?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255113000310?idApp=UINPBA00004E" "url" => "/08702551/0000003200000006/v2_201307110910/S0870255113000310/v2_201307110910/pt/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0870255113000991" "issn" => "08702551" "doi" => "10.1016/j.repc.2012.10.016" "estado" => "S300" "fechaPublicacion" => "2013-06-01" "aid" => "285" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2013;32:523-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8914 "formatos" => array:3 [ "EPUB" => 205 "HTML" => 7483 "PDF" => 1226 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Incessant slow bundle branch reentrant ventricular tachycardia in a young patient with left ventricular noncompaction" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "523" "paginaFinal" => "529" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Taquicardia ventricular por reentrada de ramo lenta e incessante em adolescente com ventrículo esquerdo não-compactado" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1348 "Ancho" => 2500 "Tamanyo" => 490235 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical ventricular tachycardia (LBB block pattern, superior axis).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sérgio Barra, Nuno Moreno, Rui Providência, Helena Gonçalves, João José Primo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Sérgio" "apellidos" => "Barra" ] 1 => array:2 [ "nombre" => "Nuno" "apellidos" => "Moreno" ] 2 => array:2 [ "nombre" => "Rui" "apellidos" => "Providência" ] 3 => array:2 [ "nombre" => "Helena" "apellidos" => "Gonçalves" ] 4 => array:2 [ "nombre" => "João José" "apellidos" => "Primo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255113000991?idApp=UINPBA00004E" "url" => "/08702551/0000003200000006/v2_201307110910/S0870255113000991/v2_201307110910/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Ischemia induced by coronary steal through a patent mammary artery side branch: A role for embolization" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "531" "paginaFinal" => "534" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nuno Moreno, Alexandra da Silva Castro, Adriana Pereira, João Carlos Silva, Pedro Bernardo Almeida, Aurora Andrade, Maria Júlia Maciel, Paula Pinto" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Nuno" "apellidos" => "Moreno" "email" => array:1 [ 0 => "numoreno@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Alexandra" "apellidos" => "da Silva Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Adriana" "apellidos" => "Pereira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "João Carlos" "apellidos" => "Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Pedro Bernardo" "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Aurora" "apellidos" => "Andrade" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Maria Júlia" "apellidos" => "Maciel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "Paula" "apellidos" => "Pinto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia do Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Cardiologia do Hospital de São João, Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Isquemia induzida por roubo coronário através de um ramo patente da artéria mamária interna: um papel para a embolização" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1549 "Ancho" => 1667 "Tamanyo" => 212867 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A large side branch originating from the left internal mammary artery. LIMA: left internal mammary artery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary steal due to an unligated side branch of the internal mammary artery (IMA) is a rare but important condition that can cause ischemia in patients after coronary artery bypass surgery. Although this is a known phenomenon, it is not always easy to relate it to the patient's symptoms.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a patient with significant ischemia in whom an unligated side branch was successfully treated by coil embolization. This intervention can be a useful option and should be considered in the management of symptomatic patients with patent IMA side branches.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors present the case of a 67-year-old man who had undergone coronary artery bypass grafting after an acute myocardial infarction over four years previously, due to an ostial lesion in the left anterior descending (LAD) artery, with a left internal mammary artery (LIMA) to LAD bypass. One year after the procedure he was admitted to the cardiac intensive care unit for unstable angina. He underwent coronary angiography, which revealed an 80% stenosis in the bypass anastomosis, and angioplasty with a drug-eluting stent was successfully performed. The angiogram also showed a branch arising from a very proximal segment of the LIMA, not occluded during the surgery and supplying the whole lateral chest wall via numerous intercostal collaterals (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Due to the bypass stenosis the clinical importance of the patency of this vessel was not appreciated. After this angioplasty he presented with early-onset recurrent angina, and performed a treadmill stress test that was symptomatic and electrically positive for ischemia. Repeated coronary angiography showed the graft and the stent to be patent, without evolution of the native disease.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">After discharge the patient remained highly symptomatic despite optimal medical therapy.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Dobutamine stress echocardiography showed inducible ischemia in the anterior wall distribution. These findings led to a diagnosis of a probable steal phenomenon due a patent IMA side branch. Percutaneous coil embolization of this branch was performed. The left internal mammary artery was selectively cannulated with a Heartrail catheter inside a 6-F femoral guiding catheter via the right femoral artery and a microcatheter was advanced over the guidewire into the side branch. Following removal of the guidewire, detachable embolization coils (Tornado<span class="elsevierStyleSup">®</span>, Cook Medical, 4/2 mm, 4/2 mm and 3/2 mm) were placed in the side branch.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The coils were attached to a delivery wire and were released in the appropriate position. During the procedure, a dissection was detected in the proximal region of the LIMA and two biolimus and bioabsorbable polymer stents (Biomatrix 3 mm × 24 mm and 3 mm × 28 mm distal and proximal, juxtaposed) were implanted, covering the entire dissected segment. Control angiography at the end of the procedure showed the side branch still patent but with compromised flow (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>)</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">At one-month follow-up, the patient reported clinical improvement and increased functional capacity. He underwent treadmill stress testing and repeated dobutamine stress echocardiography four months after the procedure, which showed no evidence of ischemia.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Although the use of LIMA to LAD grafts as a means of revascularization is routine and effective, it is not a risk-free procedure. There can be various reasons for ischemic symptoms in patients who have undergone coronary artery bypass surgery, including incomplete revascularization at the time of surgery, progression of atheromatous disease or graft occlusion. A rare cause of recurrent symptoms can be an anomalous or persistent chest wall branch causing flow “steal”.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The hemodynamic importance of these branches is still unclear, since many patients have them, but few lead to symptoms. LIMA side branches to the chest wall have been identified both preoperatively and postoperatively in 10–20% of patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although a number of studies have reported successful occlusion of the side branches to relieve angina,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> this phenomenon has been confirmed in some studies that aimed to obtain hemodynamic data, but rejected in others.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A major argument is that LIMA side branch steal is supposedly a systolic flow diversion and not a true coronary flow steal. The arterial flow to the chest wall is predominantly systolic and out of phase with the predominantly diastolic coronary circulation.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> It has been shown that the limited functional flow reserve of the <span class="elsevierStyleItalic">in situ</span> IMA minimizes the possibility of significant flow steal from patent IMA graft collaterals, even after muscular vasodilatation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Indeed no study measuring coronary velocities in post-CABG patients has suggested that IMA side branches are of clinical significance unless there are unusual hemodynamic circumstances.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This leads many authors to argue that complete LIMA harvesting is not mandatory<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and that occlusion is unwarranted unless it can be shown to increase LIMA flow or objectively reduce myocardial ischemia.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Nevertheless, as previously stated, many reports of clinical improvement following LIMA occlusion contradict these pathophysiological studies.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Major factors contributing to IMA side branch steal may include technical errors or anatomic factors which reduce IMA run-off and possibly divert it into large side branches with lower resistance.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Several methods of occlusion of the side branches have been described, including embolization, the use of gelatin sponge particles and the combined use of drug-eluting and covered stents. Surgical ligation both via an open route and by video-assisted thoracoscopic surgery has been successfully performed. Recently, the use of vascular plugs (originally developed for closing arteriovenous fistulae) for occluding such side branches has also been described.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In our patient we used platinum coils, which are easily detected radiographically, feature synthetic fibers that promote thrombogenicity, and are ideally suited for tapering vessel situations. Although in the case described transcutaneous closure was complicated by dissection of the LIMA, coil deployment can be regarded as safe, with early mobilization and lower morbidity and mortality compared to reoperation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Given the above controversies and the different possible technical approaches with their inherent limitations, the decision to close these side branches and the way it is performed should be carefully weighed. It should only be considered when a correlation between the patency of the side branch and the patient's symptoms is indisputable.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The physiological significance of IMA side branches has been clinically and experimentally questioned. Occlusion of these branches is not recommended without objective evidence of ischemia but in our case anterior wall myocardial perfusion was clearly impaired in the setting of a patent LIMA-LAD graft and an anomalous side branch, with clinical improvement after intervention. Coronary steal due to an unligated side branch of the LIMA is rare but should be borne in mind as a possible and treatable cause of ischemia after coronary artery bypass surgery.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres212843" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec199955" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres212844" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec199956" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-08-15" "fechaAceptado" => "2012-09-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec199955" "palabras" => array:3 [ 0 => "Patent left internal mammary artery side branch" 1 => "Coronary steal syndrome" 2 => "Coil embolization" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec199956" "palabras" => array:3 [ 0 => "Ramo patente da artéria mamária interna" 1 => "Síndrome do roubo coronário" 2 => "Embolização" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A não oclusão de ramos laterais da artéria mamária interna após cirurgia de revascularização miocárdica pode causar isquemia devido ao desvio do fluxo coronário.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Os autores apresentam o caso de um homem de 67 anos de idade, com angina recorrente após revascularização miocárdica com <span class="elsevierStyleItalic">bypass</span> da artéria mamária interna esquerda para a artéria descendente anterior. O doente apresentava redução da perfusão miocárdica na parede anterior na presença de um ramo patente da artéria mamária interna. Foi realizada de forma eficaz a embolização percutânea com <span class="elsevierStyleItalic">coils</span> deste ramo com melhoria do fluxo e dos sintomas clínicos, dados confirmados com testes de avaliação de isquemia.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O roubo coronário através de ramos laterais patentes da artéria mamária ainda é um fenómeno controverso e este tipo de intervenção deve ser apenas considerada no tratamento de pacientes bem selecionados.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1549 "Ancho" => 1667 "Tamanyo" => 212867 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A large side branch originating from the left internal mammary artery. LIMA: left internal mammary artery.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 993 "Ancho" => 1000 "Tamanyo" => 122383 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Angiogram after deployment of the coils in the side branch, still patent but with compromised flow, and two stents covering the dissected LIMA segment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Internal mammary artery anomalies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.P. Bauer" 1 => "L.K. von Segesser" 2 => "A. Laske" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2007-1014041" "Revista" => array:7 [ "tituloSerie" => "Thorac Cardiovasc Surg" "fecha" => "1990" "volumen" => "38" "paginaInicial" => "312" "paginaFinal" => "315" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2264041" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939409007399" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent angina pectoris in patients with internal mammary artery to coronary artery bypass: treatment with coil embolization of unligated side branches" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Chavan" 1 => "A. Mügge" 2 => "C. Hohmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiology.200.2.8685338" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "1996" "volumen" => "200" "paginaInicial" => "433" "paginaFinal" => "436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8685338" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter of an internal mammary artery bypass graft side branch causing coronary steal syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.W. Ayres" 1 => "L. Chien-Tai" 2 => "K.H. Benzuly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cathet Cardiovasc Diagn" "fecha" => "1994" "volumen" => "31" "paginaInicial" => "301" "paginaFinal" => "303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8055571" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impaired myocardial perfusion from persistent mammary side branches: a role for functional imaging and embolization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Firstenberg" 1 => "G. Guy" 2 => "C. Bush" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Cardiol Res Pract" "fecha" => "2010" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transradial occlusion of a large intercostal branch of a left internal mammary artery graft with the novel amplatzer vascular plug 4 using a 4 French diagnostic catheter: treatment of coronary steal phenomenon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.B. Sanghvi" 1 => "J.F. Diaz Fernandez" 2 => "A.E. Gomez Menchero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Invasive Cardiol" "fecha" => "2011" "volumen" => "23" "paginaInicial" => "E113" "paginaFinal" => "E116" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21562357" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do internal mammary artery side-branches have the potential for haemodynamically significant flow steal?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "M. Gaudino" 1 => "M. Serricchio" 2 => "P. Tondi" 3 => "F. Glieca" 4 => "P. Bruno" 5 => "G. Possati" 6 => "P. Pola" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "1999" "volumen" => "15" "paginaInicial" => "251" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10333018" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Persistence of mammary artery branches and blood supply to the left anterior descending artery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Luise" 1 => "G. Teodori" 2 => "G. Di Giammarco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1997" "volumen" => "63" "paginaInicial" => "1759" "paginaFinal" => "1764" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9205180" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fallacy of thoracic side-branch steal from the internal mammary artery: analysis of left internal mammary artery coronary flow during thoracic side-branch occlusion with pharmacologic and exercise-induced hyperemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O.J.J. Guzon" 1 => "K. Klatte" 2 => "A. Moyer" 3 => "S. Khoukaz" 4 => "M.J. Kern" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cathet Cardiovasc Interv" "fecha" => "2004" "volumen" => "61" "paginaInicial" => "20" "paginaFinal" => "28" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mammary side branch steal: is this a real or even clinically important phenomenon?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Kern" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1998" "volumen" => "66" "paginaInicial" => "1873" "paginaFinal" => "1875" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9930462" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does a LIMA side branch ever need occlusion? (Why I don’t think so)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Kern" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cathet Cardiovasc Diagn" "fecha" => "1998" "volumen" => "45" "paginaInicial" => "307" "paginaFinal" => "309" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9829893" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Internal thoracic artery side branch ligation for post coronary surgery ischemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Tsakiridis" 1 => "D. Mikroulis" 2 => "V. Didilis" 3 => "G. Bougioukas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Asian Cardiovasc Thorac Ann" "fecha" => "2007" "volumen" => "15" "paginaInicial" => "339" "paginaFinal" => "341" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17664211" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003200000006/v2_201307110910/S0870255113001170/v2_201307110910/en/main.assets" "Apartado" => array:4 [ "identificador" => "362" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003200000006/v2_201307110910/S0870255113001170/v2_201307110910/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255113001170?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 8 | 7 | 15 |
| 2024 Outubro | 34 | 38 | 72 |
| 2024 Setembro | 86 | 26 | 112 |
| 2024 Agosto | 75 | 37 | 112 |
| 2024 Julho | 48 | 42 | 90 |
| 2024 Junho | 50 | 36 | 86 |
| 2024 Maio | 71 | 25 | 96 |
| 2024 Abril | 37 | 43 | 80 |
| 2024 Maro | 45 | 33 | 78 |
| 2024 Fevereiro | 37 | 29 | 66 |
| 2024 Janeiro | 41 | 26 | 67 |
| 2023 Dezembro | 30 | 38 | 68 |
| 2023 Novembro | 47 | 51 | 98 |
| 2023 Outubro | 31 | 22 | 53 |
| 2023 Setembro | 30 | 20 | 50 |
| 2023 Agosto | 29 | 21 | 50 |
| 2023 Julho | 40 | 18 | 58 |
| 2023 Junho | 40 | 20 | 60 |
| 2023 Maio | 52 | 25 | 77 |
| 2023 Abril | 38 | 9 | 47 |
| 2023 Maro | 48 | 27 | 75 |
| 2023 Fevereiro | 61 | 23 | 84 |
| 2023 Janeiro | 28 | 18 | 46 |
| 2022 Dezembro | 53 | 26 | 79 |
| 2022 Novembro | 72 | 35 | 107 |
| 2022 Outubro | 45 | 24 | 69 |
| 2022 Setembro | 35 | 35 | 70 |
| 2022 Agosto | 55 | 35 | 90 |
| 2022 Julho | 48 | 44 | 92 |
| 2022 Junho | 39 | 28 | 67 |
| 2022 Maio | 37 | 35 | 72 |
| 2022 Abril | 43 | 32 | 75 |
| 2022 Maro | 29 | 43 | 72 |
| 2022 Fevereiro | 49 | 31 | 80 |
| 2022 Janeiro | 45 | 31 | 76 |
| 2021 Dezembro | 26 | 49 | 75 |
| 2021 Novembro | 48 | 41 | 89 |
| 2021 Outubro | 57 | 50 | 107 |
| 2021 Setembro | 34 | 34 | 68 |
| 2021 Agosto | 47 | 34 | 81 |
| 2021 Julho | 31 | 43 | 74 |
| 2021 Junho | 33 | 18 | 51 |
| 2021 Maio | 32 | 37 | 69 |
| 2021 Abril | 40 | 52 | 92 |
| 2021 Maro | 66 | 33 | 99 |
| 2021 Fevereiro | 76 | 25 | 101 |
| 2021 Janeiro | 141 | 15 | 156 |
| 2020 Dezembro | 48 | 10 | 58 |
| 2020 Novembro | 55 | 22 | 77 |
| 2020 Outubro | 35 | 13 | 48 |
| 2020 Setembro | 75 | 19 | 94 |
| 2020 Agosto | 28 | 10 | 38 |
| 2020 Julho | 54 | 11 | 65 |
| 2020 Junho | 30 | 12 | 42 |
| 2020 Maio | 53 | 5 | 58 |
| 2020 Abril | 42 | 19 | 61 |
| 2020 Maro | 40 | 13 | 53 |
| 2020 Fevereiro | 71 | 23 | 94 |
| 2020 Janeiro | 31 | 28 | 59 |
| 2019 Dezembro | 55 | 17 | 72 |
| 2019 Novembro | 32 | 6 | 38 |
| 2019 Outubro | 50 | 12 | 62 |
| 2019 Setembro | 27 | 13 | 40 |
| 2019 Agosto | 42 | 8 | 50 |
| 2019 Julho | 49 | 13 | 62 |
| 2019 Junho | 58 | 16 | 74 |
| 2019 Maio | 44 | 34 | 78 |
| 2019 Abril | 28 | 36 | 64 |
| 2019 Maro | 89 | 29 | 118 |
| 2019 Fevereiro | 64 | 14 | 78 |
| 2019 Janeiro | 38 | 8 | 46 |
| 2018 Dezembro | 91 | 22 | 113 |
| 2018 Novembro | 89 | 11 | 100 |
| 2018 Outubro | 217 | 30 | 247 |
| 2018 Setembro | 42 | 10 | 52 |
| 2018 Agosto | 56 | 13 | 69 |
| 2018 Julho | 43 | 7 | 50 |
| 2018 Junho | 82 | 5 | 87 |
| 2018 Maio | 99 | 13 | 112 |
| 2018 Abril | 139 | 5 | 144 |
| 2018 Maro | 129 | 9 | 138 |
| 2018 Fevereiro | 68 | 6 | 74 |
| 2018 Janeiro | 138 | 3 | 141 |
| 2017 Dezembro | 184 | 12 | 196 |
| 2017 Novembro | 116 | 11 | 127 |
| 2017 Outubro | 40 | 9 | 49 |
| 2017 Setembro | 63 | 12 | 75 |
| 2017 Agosto | 79 | 18 | 97 |
| 2017 Julho | 37 | 14 | 51 |
| 2017 Junho | 40 | 12 | 52 |
| 2017 Maio | 60 | 6 | 66 |
| 2017 Abril | 51 | 3 | 54 |
| 2017 Maro | 79 | 11 | 90 |
| 2017 Fevereiro | 92 | 7 | 99 |
| 2017 Janeiro | 30 | 3 | 33 |
| 2016 Dezembro | 36 | 10 | 46 |
| 2016 Novembro | 51 | 13 | 64 |
| 2016 Outubro | 71 | 11 | 82 |
| 2016 Setembro | 91 | 11 | 102 |
| 2016 Agosto | 28 | 6 | 34 |
| 2016 Julho | 11 | 10 | 21 |
| 2016 Junho | 2 | 0 | 2 |
| 2016 Maio | 5 | 7 | 12 |
| 2016 Abril | 50 | 3 | 53 |
| 2016 Maro | 88 | 10 | 98 |
| 2016 Fevereiro | 107 | 31 | 138 |
| 2016 Janeiro | 119 | 10 | 129 |
| 2015 Dezembro | 93 | 13 | 106 |
| 2015 Novembro | 63 | 5 | 68 |
| 2015 Outubro | 75 | 8 | 83 |
| 2015 Setembro | 91 | 15 | 106 |
| 2015 Agosto | 95 | 13 | 108 |
| 2015 Julho | 134 | 12 | 146 |
| 2015 Junho | 66 | 3 | 69 |
| 2015 Maio | 70 | 10 | 80 |
| 2015 Abril | 68 | 14 | 82 |
| 2015 Maro | 54 | 5 | 59 |
| 2015 Fevereiro | 60 | 5 | 65 |
| 2015 Janeiro | 84 | 11 | 95 |
| 2014 Dezembro | 67 | 15 | 82 |
| 2014 Novembro | 47 | 8 | 55 |
| 2014 Outubro | 62 | 10 | 72 |
| 2014 Setembro | 44 | 25 | 69 |
| 2014 Agosto | 52 | 12 | 64 |
| 2014 Julho | 57 | 12 | 69 |
| 2014 Junho | 53 | 7 | 60 |
| 2014 Maio | 66 | 13 | 79 |
| 2014 Abril | 61 | 19 | 80 |
| 2014 Maro | 79 | 18 | 97 |
| 2014 Fevereiro | 76 | 21 | 97 |
| 2014 Janeiro | 94 | 20 | 114 |
| 2013 Dezembro | 75 | 11 | 86 |
| 2013 Novembro | 74 | 20 | 94 |
| 2013 Outubro | 71 | 16 | 87 |
| 2013 Setembro | 70 | 29 | 99 |
| 2013 Agosto | 82 | 36 | 118 |
| 2013 Julho | 88 | 26 | 114 |
Mostrar tudo
