Interventional blockade of the internal mammary artery for the treatment of coronary artery disease:anatomy,clinical studies,and future perspectives
10.3969/j.issn.1004-8812.2025.05.007
- VernacularTitle:内乳动脉介入封堵治疗冠心病的解剖基础、临床研究与未来展望
- Author:
Shao-hui XIONG
1
;
Li ZHANG
;
Kong-jie LU
;
Zhen-feng CHENG
Author Information
1. 湖州师范学院医学院(护理学院),浙江湖州 313000
- Publication Type:Journal Article
- Keywords:
Internal mammary artery;
Coronary artery disease;
Collateral circulation;
Myocardial perfusion
- From:
Chinese Journal of Interventional Cardiology
2025;33(5):284-287
- CountryChina
- Language:Chinese
-
Abstract:
In the mid-20th century,internal mammary artery(IMA)ligation attracted attention for improving myocardial ischemia survival and relieving angina symptoms in animals,but was eliminated after sham-operation trials confirmed that its efficacy stemmed from a placebo effect.Recent advances in interventional techniques have led to the revival of distal IMA blockade,which has been shown to improve myocardial perfusion by modulating collateral circulation.Randomized controlled trials further showed that angina relief was significantly better in the blockade group than in the sham-operated group,especially in right coronary artery(RCA)and left anterior descending(LAD)lesions,but not in the ileocecal branch due to the lack of IMA collateral connections.Anatomy suggests that the internal mammary artery forms a natural collateral pathway to the RCA/LAD via the pericardial phrenic artery,which is the anatomic basis for its efficacy.Current technical limitations include incomplete occlusion,device-related complications,and insufficient evidence of long-term prognosis.Future studies are needed to optimize the design of occlusion devices,explore combined therapeutic strategies,and conduct controlled studies with conventional revascularization techniques.In this review,we systematically review the 100-year evolution of IMA occlusion,the paradigm shift from surgical ligation to precision intervention,analyze its anatomical and hemodynamic mechanisms,integrate evidence-based evidence and propose screening criteria for indications,and provide a new pathway for individualized treatment of high-risk patients who cannot tolerate coronary artery bypass grafting/percutaneous coronary intervention.
