{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T12:22:03Z","timestamp":1778242923031,"version":"3.51.4"},"reference-count":15,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,12,10]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>The internal mammary artery has become the primary conduit for the surgical revascularisation of the left anterior descending artery. Large side branches of internal mammary artery are typically ligated during cardiac surgery to avoid a potential coronary steal phenomenon. However, ligation of side branches can be unsuccessful due to the technically difficult surgical exploration of internal mammary artery branches. In this article, we present a case of a man who suffered from exertion angina pectoris despite successful surgical revascularisation of occluded left anterior descending artery by the internal mammary artery bypass. The coronary steal syndrome caused by the mighty side branch of internal mammary artery, that is, lateral costal artery was concluded as the reason of exertional angina. The endovascular procedure was performed and the lateral costal artery was successfully occluded using vascular plug. The occlusion of lateral costal artery has led to a complete disappearance of the exertional angina.<\/jats:p>","DOI":"10.1136\/bcr-2023-256654","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T12:35:15Z","timestamp":1703162115000},"page":"e256654","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Exertional angina after cardiac bypass surgery successfully solved by endovascular occlusion of unligated lateral costal artery"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0820-1328","authenticated-orcid":false,"given":"Marek","family":"Hud\u00e1k","sequence":"first","affiliation":[{"name":"Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Ko\u0161ice, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00e1ria","family":"Ra\u0161iov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Ko\u0161ice, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matej","family":"Mo\u0161\u010dovi\u010d","sequence":"additional","affiliation":[{"name":"Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Ko\u0161ice, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8120-558X","authenticated-orcid":false,"given":"Martin","family":"Ko\u0161\u010do","sequence":"additional","affiliation":[{"name":"Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Ko\u0161ice, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,12,21]]},"reference":[{"key":"2025082803201337000_16.12.e256654.1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.02.43"},{"key":"2025082803201337000_16.12.e256654.2","unstructured":"Clemente CD . Gray\u2019s anatomy. 30th Am edn. Baltimore: Williams and Wilkins, 1985: 706\u20139."},{"key":"2025082803201337000_16.12.e256654.3","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-022-14318-3","article-title":"Clinical and anatomical features of the lateral costal artery and vein","volume":"12","author":"Nakazawa","year":"2022","journal-title":"Sci Rep"},{"key":"2025082803201337000_16.12.e256654.4","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1007\/s00330-020-07292-9","article-title":"Assessment of lateral costal artery with CT angiography: determination of prevalence and vessel length in the general population and its potential impact for coronary artery bypass grafting","volume":"31","author":"Houbois","year":"2021","journal-title":"Eur Radiol"},{"key":"2025082803201337000_16.12.e256654.5","first-page":"307","article-title":"Does a LIMA side branch ever need occlusion? (why I don\u2019t think so)","volume":"45","author":"Kern","year":"1998","journal-title":"Cathet Cardiovasc Diagn"},{"key":"2025082803201337000_16.12.e256654.6","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.ijcard.2004.01.046","article-title":"Internal mammary artery steal syndrome secondary to an anomalous lateral branch","volume":"101","author":"Lakkireddy","year":"2005","journal-title":"Int J Cardiol"},{"key":"2025082803201337000_16.12.e256654.7","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1111\/j.1540-8191.2011.01297.x","article-title":"Unligated left internal mammary artery side branch resulting in coronary artery steal syndrome","volume":"26","author":"Chalvatzoulis","year":"2011","journal-title":"J Card Surg"},{"key":"2025082803201337000_16.12.e256654.8","article-title":"Physiologic functional evaluation of left internal mammary artery graft to left anterior descending coronary artery steal due to unligated first thoracic branch in a case of refractory angina","volume":"2016","author":"Sawaya","year":"2016","journal-title":"Case Rep Cardiol"},{"key":"2025082803201337000_16.12.e256654.9","first-page":"291","article-title":"Lack of evidence for improvement in internal mammary graft flow by occlusion of side branch","volume":"42","author":"Abhyankar","year":"1997","journal-title":"Cathet Cardiovasc Diagn"},{"key":"2025082803201337000_16.12.e256654.10","first-page":"20","article-title":"Fallacy of thoracic side-branch steal from the internal mammary artery: analysis of left internal mammary artery coronary flow during thoracic side-branch occlusion with pharmacologic and exercise-induced hyperemia","volume":"61","author":"Guzon","year":"2004","journal-title":"Catheter Cardiovasc Interv"},{"key":"2025082803201337000_16.12.e256654.11","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.10224"},{"key":"2025082803201337000_16.12.e256654.12","doi-asserted-by":"crossref","first-page":"2805","DOI":"10.1093\/eurheartj\/ehad327","article-title":"Coronary steal: how many thieves are out there","volume":"44","author":"Achim","year":"2023","journal-title":"Eur Heart J"},{"key":"2025082803201337000_16.12.e256654.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(97)00366-4"},{"key":"2025082803201337000_16.12.e256654.14","first-page":"200","article-title":"The value of exercise SPET for the detection of coronary artery steal syndrome secondary to unligated major side branch of left internal mammary artery","volume":"19","author":"Beton","year":"2016","journal-title":"Hell J Nucl Med"},{"key":"2025082803201337000_16.12.e256654.15","first-page":"97","article-title":"Left internal mammary artery side branch intervention in the management of coronary steal syndrome following coronary artery bypass grafting","volume":"97","author":"Mangels","year":"2021","journal-title":"Catheter Cardiovasc Interv"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-256654","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:20:17Z","timestamp":1756376417000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-256654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":15,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,21]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/bcr-2023-256654"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-256654","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}