LIMA-LAD Steal Syndrome as a Cause of Post-CABG Angina
Recommended Citation
Multani NS, Affas ZR, and Alexander PB. LIMA-LAD Steal Syndrome as a Cause of Post-CABG Angina. JACC Case Rep 2025;30(25):104828.
Document Type
Article
Publication Date
8-27-2025
Publication Title
JACC Case Rep
Abstract
BACKGROUND: Coronary steal from unligated side branches of the left internal mammary artery (LIMA) after coronary artery bypass grafting may lead to recurrent angina.
CASE SUMMARY: A 64-year-old man presented with recurrent angina 2 years after coronary artery bypass grafting. Imaging showed perfusion defects in the territory of the left anterior descending artery (LAD). Coronary angiography revealed a large patent LIMA side branch. A percutaneous vascular plug successfully occluded the side branch, with symptom resolution.
DISCUSSION: There is conflicting evidence regarding the diagnosis and treatment of coronary steal syndrome from LIMA graft. Despite the lack of formal guidelines, reversible anterior wall defects on stress testing may help identify patients with clinically significant symptoms.
TAKE-HOME MESSAGES: The side branches of the LIMA when unligated represent a relatively common anatomical variation that could have clinical implications. Large, unligated side branches when accompanied by anterior wall ischemia may indicate a diagnosis of LIMA-LAD steal amenable to percutaneous intervention.
PubMed ID
40883084
Volume
30
Issue
25
First Page
104828
Last Page
104828
