Acute thrombosis of the left internal mammary artery graft 14 years after coronary bypass surgery

Causes for stenosis of the left internal mammary artery (LIMA) graft are flow competition from the native vessel, narrowing at the anastomotic sites, atherosclerosis, fixed kinks within the graft, smooth tubular stenosis, dissection, and spasm (1, 2). Acute thrombosis of the LIMA, however, is rare and usually presents in the early post-operative period due to inadequate anti-thrombotic treatment or incompetent surgical technique (3-5). In this report, we represent a case of acute thrombotic occlusion of the LIMA, 14 years after coronary artery bypass grafting surgery (CABG), presenting with acute myocardial infarction (AMI), and managed with primary percutaneous coronary intervention (PCI).