Int J Cardiol. 2010 Jul 23;142(3):e42-4. doi: 10.1016/j.ijcard.2008.11.184. Epub 2009 Jan 10.
Late occlusion of the left internal mammary artery (LIMA) is rare, and its pathological basis is unknown. We present a case of acute occlusion of the LIMA in a 77-year-old woman, 7 years after graft surgery, causing fatal myocardial infarction. Diagnostic angiography of the LIMA revealed a proximal occlusion just beyond the LIMA origin which re-canalised after repeated injection of contrast with near complete restoration of LIMA patency and flow with smooth angiographic appearance. Despite initial diminution of pain and electrocardiographic changes with recanalisation, pain and ST changes returned and the patient died. Restoration of near normal vessel patency with angiography suggests that the basis of this occlusion is not atherosclerotic plaque rupture, but is more likely to represent in situ thrombosis or, less likely, localized spasm. Early recognition of the possibility of LIMA occlusion may direct initial angiography to the LIMA rather than the native circulation, and reduce the time to reperfusion.
左内乳动脉（LIMA）晚期闭塞罕见，其病理基础尚不清楚。我们报告了一例 77 岁女性 LIMA 急性闭塞的病例，该患者在移植手术后 7 年发生致命性心肌梗死。LIMA 的诊断性血管造影显示，LIMA 起源处近端闭塞，经反复注射造影剂后再通，LIMA 通畅性和血流几乎完全恢复，血管造影外观光滑。尽管再通后疼痛和心电图改变最初有所减轻，但疼痛和 ST 改变再次出现，患者死亡。血管造影显示，近正常的血管通畅性恢复表明这种闭塞的基础不是动脉粥样硬化斑块破裂，而是原位血栓形成的可能性更大，局部痉挛的可能性较小。早期认识到 LIMA 闭塞的可能性可能会导致初始血管造影将 LIMA 而不是原生循环作为目标，从而减少再灌注时间。
