Summary

An 82-year-old woman re-presented with severe angina many years after coronary artery bypass surgery. Myocardial perfusion imaging suggested reversible ischaemia in the inferior territory. Diagnostic angiography demonstrated no vein grafts, an occluded right internal mammary artery graft (RIMA), and a patent left internal mammary graft. The native right coronary was stenosed in several sections and she was referred for angioplasty to this artery. After initial balloon inflation in the native right coronary, to our surprise a large arterial graft was revealed–the apparently blocked RIMA. In fact the RIMA was not occluded; the graft was assumed to be pedicle whereas in fact it had been grafted to the ascending aorta. The interventional strategy was revised and both the RIMA and native right coronary artery were successfully treated.