Dissection of a Left Internal Mammary Artery Bypass

A male patient aged over 70 years was brought to us in cardiogenic shock following 60-min resuscitation—by means of manual chest compression using a mechanical chest compression device—due to ventricular fibrillation. The patient had undergone coronary bypass surgery 4 years previously with the left internal mammary artery (LIMA) to the left anterior descending artery. Angiography showed acute occlusion of the left circumflex artery, which was successfully recanalized, thereby stabilizing the patient’s condition. An abnormality in the LIMA bypass was also detected (Figure a). Intravascular ultrasound confirmed a dissection (Figure b), which was treated with two drug-eluting stents. Dissection of a LIMA bypass is a serious complication since it can trigger acute coronary syndrome. Known triggers include diagnostic angiography and mechanical stress due to arm movements. The clinical course here suggests that the dissection was triggered by resuscitation, which could be explained by the shear stress exerted on the chest wall during the procedure and points to an additional mechanism of LIMA bypass dissection.

Figure

Angiogram / Intravascular ultrasound

Dr. med. Sebastian Weyand, Dr. med. Stephanie Löbig, Prof. Dr. med. Peter Seizer, Abteilung für Kardiologie, Ostalb-Klinikum Aalen, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Weyand S, Löbig S, Seizer P: Dissection of a left internal mammary artery bypass. Dtsch Arztebl Int 2025; 122: 95. DOI: 10.3238/arztebl.m2024.0217