Successful percutaneous treatment of a catastrophic left internal mammary artery graft avulsion occurring 4 weeks post-coronary artery bypass grafting surgery: a case report

BACKGROUND: Avulsion of the left internal mammary artery (LIMA) graft near the anastomosis to the left anterior descending artery (LAD) artery post-coronary artery bypass grafting (CABG) is a rare but potentially catastrophic complication which can result in sudden ischaemia, haemodynamic compromise and life-threatening bleeding into the pericardium. CASE SUMMARY: We report a case of a spontaneous LIMA graft avulsion at the site of the anastomosis to the LAD artery, which occurred 4 weeks post-conventional CABG surgery and resulted in anterior myocardial infarction (MI), cardiac tamponade and cardiogenic shock. This life-threatening event was treated by deploying a covered stent in the LAD artery and by coiling the dehisced LIMA graft. DISCUSSION: To our knowledge, this is the first report of late LIMA graft avulsion that has been uniquely and successfully treated by percutaneous coronary intervention.