A rare case of successful recanalization of the anterior interventricular artery through a mammary-coronary graft in a patient 15 years after coronary artery bypass grafting

Progression of atherosclerosis in patients with coronary artery disease (CAD) who underwent surgical treatment, manifests itself in the development of dysfunction of the shunts, and in worsening of the condition of native coronary arteries. Accordingly, there is an increase in the number of patients who require repeated aggressive treatments. In cases where it is technically possible to perform repeated coronary artery bypass graft (CABG) and/or percutaneous interventions (PCI), there is no question of treatment tactics. But there are times when implementation of interventions is associated with a high risk and optimal medication therapy does not have the proper effect. In a patient with multiple lesions of the coronary arteries 15 years after CABG in connection with the progression of atherosclerosis, the occlusion of anterior interventricular artery (AIVA) is distal to the mammary-coronary anastomosis, the occlusion of the venous shunt to the right coronary artery. Effort angina (class III) is caused by myocardial ischemia in the AIVA territory. Patient underwent surgery for recanalization of AIVA through mammary-coronary shunt.