Use of the Amplatzer Vascular Plug® for treatment of coronary steal

The left internal mammary artery (LIMA) is a widely used conduit during coronary artery bypass graft surgery because of its excellent long-term patency. Although large LIMA side branches are typically ligated during the surgery, the occurrence of a coronary steal phenomenon related to these side branches following surgery remains controversial. A variety of devices, including coil embolization and gelatin sponge particles, have been used in the percutaneous treatment of LIMA side branch induced coronary steal. The Amplatzer Vascular Plug® has recently been applied in variety of clinical situations, including the occlusion of aortopulmonary collaterals, patent ductus arteriosus and pulmonary arteriovenous malformations. The Amplatzer Vascular Plug® is a self-expandable, cylindrical device made from nitinol that offers several potential advantages in this setting including ease of delivery, a wide range of device sizes and the ability to safely remove the device if placement location in not optimal. In this case report, we present a patient with objective ischemia in the left anterior descending artery distribution secondary to coronary steal from a large LIMA side branch that was successfully treated using the Amplatzer Vascular Plug®.