scholarly journals Coronary Subclavian Steal Syndrome: An Unusual Cause of Angina in a Post-CABG Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Usman Younus ◽  
Brandon Abbott ◽  
Deepika Narasimha ◽  
Brian J. Page
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Left Internal Mammary Artery ◽  
Rare Complication ◽  
Artery Bypass ◽  
Subclavian Steal Syndrome ◽  
Subclavian Steal ◽  
Nuclear Stress Testing ◽  
Coronary Subclavian Steal Syndrome ◽  
Steal Syndrome

Coronary subclavian steal syndrome is a rare complication of coronary artery bypass grafting surgery (CABG) when a left internal mammary artery (LIMA) graft is utilized. This syndrome is characterized by retrograde flow from the LIMA to the left subclavian artery (SA) when a proximal left SA stenosis is present. We describe a unique case of an elderly male who underwent CABG 6 years ago who presented with prolonged chest pain, mildly elevated troponins, and unequal pulses in his arms. A CTA of the chest demonstrated a severely calcified occluded proximal left SA jeopardizing his LIMA graft. Subclavian angiography was performed with an attempt to revascularize the patient’s occluded left SA which was unsuccessful. We referred the patient for nuclear stress testing which demonstrated a moderate size area of anterior ischemia on imaging; the patient exercised to a fair exercise capacity of 7 METS with no chest pain and no ECG changes. Subsequent coronary angiography showed severe native three-vessel coronary artery disease with intermittent retrograde blood flow from the LIMA to the left SA distal to the occlusion, jeopardizing perfusion to the left anterior descending (LAD) coronary artery distribution. He declined further options for revascularization and was discharged with medical management.

Coronary Subclavian Steal Syndrome: A Contemporary Review

Cardiology ◽  
2020 ◽  
Vol 145 (9) ◽  
pp. 601-607
Author(s):  
Hassan M. Lak ◽  
Rohan Shah ◽  
Beni Rai Verma ◽  
Eric Roselli ◽  
Francis Caputo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Subclavian Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Subclavian Steal Syndrome ◽  
Subclavian Steal ◽  
Internal Mammary ◽  
Coronary Subclavian Steal Syndrome ◽  
The Cost ◽  
Steal Syndrome

Coronary subclavian steal syndrome (CSSS) is a rare cause of angina. It occurs in patients with prior coronary artery bypass grafting and, specifically, a left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft and co-existent significant subclavian artery stenosis. In this context, there is retrograde blood flow through the LIMA to LAD graft to supply the subclavian artery beyond the significant stenosis. This potentially occurs at the cost of compromising coronary artery perfusion dependent on the LIMA graft. In this review, we present a case of a middle-aged female who suffered from CSSS and review the literature for the contemporary diagnosis and management of this condition.

scholarly journals A Case Report of Coronary-Subclavian Steal Syndrome Treated with Carotid to Axillary Artery Bypass

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
Wissam Al-Jundi ◽  
Aiman Saleh ◽  
Kathryn Lawrence ◽  
Sohail Choksy
Keyword(s):  
Case Report ◽  
Subclavian Artery ◽  
Axillary Artery ◽  
Rare Complication ◽  
Standard Procedure ◽  
Artery Bypass ◽  
Subclavian Steal Syndrome ◽  
Subclavian Steal ◽  
Coronary Subclavian Steal Syndrome ◽  
Steal Syndrome

Coronary-subclavian steal syndrome results from atherosclerotic disease of the proximal subclavian artery causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass. This rare complication of cardiac revascularisation leads to recurrence of myocardial ischaemia. When feasible, subclavian angioplasty and/or stent placement can provide acceptable result for these patients. Vascular reconstruction through carotid to subclavian artery bypass has been the standard procedure of choice. Other interventions in literature include axilloaxillary bypass and subclavian carotid transposition. This case report describes the use of carotid axillary artery bypass for the treatment of coronary-subclavian steal syndrome.

scholarly journals High-Risk Acute Coronary Syndrome in a Patient with Coronary Subclavian Steal Syndrome Secondary to Critical Subclavian Artery Stenosis

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Zaher Fanari ◽  
Niksad Abraham ◽  
Sumaya Hammami ◽  
Wasif A. Qureshi
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Subclavian Artery ◽  
Left Ventricular ◽  
Subclavian Steal Syndrome ◽  
Coronary Syndrome ◽  
Subclavian Steal ◽  
Coronary Subclavian Steal Syndrome ◽  
Steal Syndrome

Patients with multivessel coronary artery disease are more likely to have extensive atherosclerosis that involves other major arteries. Critical subclavian artery (SCA) stenosis can result in coronary subclavian steal syndrome that may present as recurrent ischemia and even myocardial infarction in patients with coronary artery bypass graft (CABG). In patients with concomitant severe native coronary disease, occluded saphenous venous grafts (SVG) to other arteries, percutaneous intervention on critical subclavian artery (SCA) stenosis that will compromise the blood flow to left internal mammary graft (LIMA) and left anterior descending (LAD) artery will be a high-risk procedure and may be associated with cardiogenic shock, especially in patients with preexisting ischemic cardiomyopathy. The use of percutaneous left ventricular (LV) assist device like Impella will offer better hemodynamic support and coronary perfusion and therefore results in decreased myocardial damage, maximized residual cardiac function, and lower incidence of cardiogenic shock.

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