ECG-gated coronary CT angiogram
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3D images show a left internal mammary artery (LIMA) graft to the LAD, with patent graft and accompanying surgical clips. There is also a trail of clips without an accompanying artery (arrows) from the aorta to the first obtuse marginal branch (OM1). Appearances are highly suggestive of aorto-coronary graft occlusion, which is confirmed on the axial images. Note that this occluded graft could be easily missed on source images, if the 3D images were not reviewed first. Also, the OM1 proximal and distal to the occluded graft is patent.