Stylized digital illustration of a human heart with arteries leading to a city skyline, symbolizing successful cardiac intervention.

Beating the Odds: How a 54-Year-Old Diabetic Woman Received Life-Saving Heart Treatment

Beau Callahan in Health & Wellness December 2025 • 5 min read.

"A rare procedure offers hope for complex coronary artery disease in a type 1 diabetic patient, showcasing the power of innovative interventions."

Managing heart disease in individuals with type 1 diabetes presents unique challenges. The convergence of these two conditions often leads to more complex and aggressive forms of coronary artery disease, demanding innovative and tailored treatment strategies. When the primary artery supplying blood to the heart, the left anterior descending artery (LAD), becomes blocked, the situation requires immediate attention. This is even more critical when the blockage occurs near or involves a previous bypass graft, such as the left internal mammary artery (LIMA).

Traditionally, both surgery (CABG) and percutaneous interventions (PCI) have been employed to tackle such complex cases. However, when the LAD stenosis is located distally to a LIMA anastomosis (connection), treatment options become less clear-cut. There's limited data available to unequivocally endorse one approach over another, leading to a clinical gray area where the expertise and judgment of the medical team are paramount.

This article delves into a remarkable case where a 54-year-old woman, grappling with chronic stable angina and type 1 diabetes, underwent a successful percutaneous angioplasty of the LAD via the LIMA. This case highlights the intricacies of managing coronary artery disease in diabetic patients and showcases the potential of innovative interventions to improve patient outcomes.

A Unique Case: Navigating Complex Coronary Artery Disease in a Diabetic Patient

Stylized digital illustration of a human heart with arteries leading to a city skyline, symbolizing successful cardiac intervention.

The patient, a 54-year-old woman with a history of coronary artery disease and type 1 diabetes (diagnosed at age 32), was admitted to the cardiology department due to worsening angina symptoms. Her medical history also included hypercholesterolemia. She had previously experienced an ST-elevation myocardial infarction (STEMI) of the anterior wall in 2005, which was treated with primary angioplasty and bare metal stent implantation in the LAD artery.

In 2007, due to worsening angina, a coronary angiography revealed significant progression of coronary artery disease, including: 99% restenosis at the site of the previous bare metal stent in the proximal LAD segment, significant stenosis in the right coronary artery (RCA) and circumflex artery (Cx). Consequently, the patient underwent coronary artery bypass grafting (CABG) with LIMA implantation to the LAD and saphenous vein grafts to the RCA and a marginal branch.

LIMA (Left Internal Mammary Artery): A high-patency vessel harvested from beneath the chest wall and grafted to the LAD.
RCA (Right Coronary Artery): Supplies blood to the right side of the heart, inferior wall, and posterior septum.
Cx (Circumflex Artery): Supplies blood to the lateral and posterior aspects of the left ventricle.
CCS Class III Angina: Characterized by marked limitations in ordinary physical activity.
HbA1c: Measures average blood sugar levels over the past 2-3 months.

Despite these interventions, her glycemic control remained suboptimal (HbA1c: 9.85%), necessitating intensified insulin therapy and close monitoring by a diabetologist. In August 2012, she was readmitted with worsening angina symptoms (CCS class III), confirmed by a treadmill test. An echocardiogram revealed regional systolic wall motion abnormalities, indicating reduced heart muscle function in the area affected by the previous myocardial infarction. Her left ventricular ejection fraction was 54%. Biochemical tests showed elevated glycated hemoglobin (HbA1c: 8.83%) and an LDL cholesterol level of 74 mg/dl (on simvastatin).

Hope for the Future

This case demonstrates the feasibility and efficacy of PCI via LIMA in select patients with complex coronary artery disease and diabetes. While individual decisions are paramount, this approach offers another option for improving outcomes and quality of life. Adequate diabetes management remains a critical factor in preventing future cardiac events.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5114/pwki.2013.34035, Alternate LINK

Title: Left Anterior Descending Artery Percutaneous Coronary Intervention Via The Left Internal Mammary Artery In A 54-Year-Old Type 1 Diabetic Woman: A

Subject: Cardiology and Cardiovascular Medicine

Journal: Advances in Interventional Cardiology

Publisher: Termedia Sp. z.o.o.

Authors: Radosław Kręcki, Jarosław Kasprzak

Published: 2013-01-01

Everything You Need To Know

What is a percutaneous coronary intervention (PCI) and why is it relevant in this scenario?

The percutaneous coronary intervention (PCI) is a procedure where a blocked coronary artery is opened using a catheter with a balloon or stent. In this case, the PCI was performed via the left internal mammary artery (LIMA), which was previously grafted to the left anterior descending artery (LAD). This is significant because it offers a less invasive option for treating coronary artery disease, especially when the blockage is near a previous bypass graft, improving outcomes and the quality of life.

What is the left anterior descending artery (LAD) and why is it important?

The left anterior descending artery (LAD) is a major blood vessel that supplies blood to the front of the heart. It is critical because its blockage can lead to a heart attack. In the context of the article, the LAD was blocked, and the intervention aimed to restore blood flow to this vital area. The case highlights the importance of addressing LAD blockages, especially in patients with diabetes and previous interventions such as the LIMA graft.

What is the left internal mammary artery (LIMA) and why is it important in this case?

The left internal mammary artery (LIMA) is a blood vessel taken from the chest wall and used to bypass a blocked coronary artery. It is important because it's known for high patency rates, meaning it tends to stay open for a long time. The LIMA was used in this case as a conduit for performing a percutaneous coronary intervention (PCI) to the LAD, showcasing its versatility in complex cases. The presence of the LIMA graft changed the approach to treat the LAD blockage, providing a pathway for intervention.

How does type 1 diabetes affect heart health?

Type 1 diabetes impacts heart health by increasing the risk of coronary artery disease. High blood sugar levels over time can damage blood vessels, leading to blockages. In this case, the patient's diabetes and other conditions like hypercholesterolemia contributed to complex heart disease, making the treatment more challenging. Managing diabetes is critical for preventing future cardiac events. The HbA1c levels indicate the average blood sugar control over time, which is a key indicator of diabetes management effectiveness.

What does CCS Class III Angina mean?

CCS Class III Angina is characterized by marked limitations in ordinary physical activity. This means the patient experienced chest pain or discomfort even during everyday tasks. It is significant because it reflects the severity of the coronary artery disease and the impact on the patient's daily life. In this case, the worsening of angina symptoms prompted further investigation and intervention to improve the patient's quality of life.