Treatment of symptomatic acute internal mammary artery graft dissection by percutaneous stent placement.

A 73-year-old man was admitted for angiographic evaluation of angina grade II. In 1994, he was operated for severe triple vessel coronary artery disease, with left internal mammary artery graft to the left anterior descending artery and two venous grafts to the obtuse marginal of the circumflex artery and to the right coronary artery respectively. He had remained symptoms-free until 2 weeks ago when he started complaining of angina grade II. An exercise test was positive for ischemia at an early stage. Angiography revealed proximal occlusion of left anterior descending artery, mid circumflex artery and mid right coronary artery, whereas the left internal mammary artery graft to the left anterior descending artery and the venous grafts to the circumflex artery and right coronary artery were patent, with minimal atherosclerotic lesions at the periphery of the vessels. At the end of the procedure, the patient complained of severe retrosternal pain, accompanied by ST segment elevation in the precordial leads (Fig. 1). Coronary angiogram was repeated, and an extensive dissection at the first