ST-Segment elevation acute myocardial infarction due to severe hypotension and proximal left subclavian artery stenosis in a prior coronary artery bypass graft patient (original) (raw)
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Archivos de cardiología de México
A 54-year male with previous triple vessel coronary artery and aorto-bi-femoral bypass graft surgeries complained of crescent angina. Stress induced myocardial ischemia on echocardiography was demonstrated. We performed direct stenting of a saphenous vein graft to the right coronary artery, via right radial approach. Subsequently stenting of a severe left subclavian artery proximal stenosis was performed via right brachial approach in order to relieve an overt myocardial ischemia in the territory supplied by a patent left internal mammary artery graft originated distally to the left subclavian stenosis. The finding of a total left axillary artery occlusion complement the pathogenesis of myocardial ischemia produced by limited anterograde flow and not driven by the common flow reversal mechanism of a typical coronary-subclavian steal syndrome.
Journal of Vascular Surgery, 1990
The internal mammary artery is used with increasing frequency for myocardial revascularization. However, preoperative coronary angiography does not always provide adequate visualization of subclavian arteries. If a proximal subclavian artery stenosis exists or develops in a patient who has myocardial revascularization with the internal mammary artery, graft malfunction can occur resulting in myocardial ischemia. We have identified four cases of internal mammary artery graft malfunction at our own institution and identified an additional 12 cases from the literature. These 16 cases are analyzed for age, sex, time of onset of symptoms, clinical findings, method of revascularization, and longterm follow-up. Sixty-three percent of the patients were men, and the mean age was 52.9 +-9.0 years. Onset of symptoms occurred after a mean interval of 25.1 months from the time of myocardial revascularization. Three patients had asymptomatic reversal of flow in the internal mammary artery as diagnosed by coronary arteriography during routine follow-up examination before 1980. One death after internal mammary arterycoronary bypass grafting was related to immediate malfunction. In the remaining 12 patients with symptomatic malfunction, all but one were treated by placement of a carotidsubclavian bypass graft with no mortality. Relief of myocardial ischemia was complete in 93% of the patients with a mean follow-up of 29.3 months. Carotid-subclavian bypass grafting appears to be the treatment of choice for the usual management of internal mammary artery graft dysfunction. Careful preoperative evaluation and postoperative follow-up of the subclavian arteries, even by simple comparison of bilateral arm blood pressure should help reduce the incidence of this syndrome (J VAsc SURG 1990;11:659-64.)
Catheterization and Cardiovascular Diagnosis, 1994
Subclavian artery stenosis is a rare cause of recurrent myocardial ischemia in patients who have undergone left internal mammary-coronary artery bypass grafting. A patient with this syndrome was successfully treated by placement of Palmaz biliary stents in the left subclavian artery. Angiographic and hemodynamic evidence of restricted subclavian flow resolved following stenting, as did the patient's unstable angina syndrome. Endoluminal stenting of the proximal subclavian artery for the treatment of coronary-subclavian steal can be performed safely and provides an alternative to other forms of surgical or percutaneous (PTCA, directional atherectomy) revascularization for treatment of this disorder. o iw4 Wiley-Liss, Inc.
Case Reports in Medicine, 2012
Coronary subclavian steal syndrome with retrograde blood flow in the left internal mammary-coronary bypass graft is a rare but severe complication of cardiac surgery. The authors present a case of a 68-year-old man after coronary-artery bypass grafting using an internal mammary artery. He had been suffering from angina pectoris for the last several years before surgery. The patient was resuscitated at home by emergency medical service because of primary ventricular fibrillation due to an acute myocardial infarction 5 years after surgery. An occlusion of the left subclavian artery with the retrograde blood flow in the left internal mammary coronary bypass was found. This could have been the cause of insufficiency in coronary blood flow and ischemia of the myocardial muscle. The subclavian artery occlusion was successfully treated with percutaneous transluminal angioplasty and implantation of 2 stents. The patient remained free of any symptoms 2 years after this procedure.
Journal of Cardiovascular Imaging, 2021
https://e-jcvi.org A 74-year-old woman with sub-occlusive left main coronary artery disease and moderate aortic stenosis was submitted to left internal mammary artery (LIMA) grafting to the left anterior descending artery (LAD), saphenous vein grafting to the second obtuse marginal branch, and surgical aortic valve replacement with a bioprosthesis in 2015. Two years ago, she was admitted for acute coronary syndrome (ACS) due to occlusion of the venous graft and received conservative treatment. This time, she presented to the emergency department with left arm coldness and oppressive precordial pain. The electrocardiogram was in sinus rhythm with STsegment elevation in lead augmented vector right and depression in all other leads (Figure 1). A transthoracic echocardiogram showed severe left ventricular dysfunction and normally functioning bioprosthesis. A coronary angiography was performed revealing an occlusive thrombus in the proximal left subclavian artery (Figures 2 and 3 and Mov...
International Journal of Cardiology, 2009
17] Abramson JL, Veledar E, Weintraub WS, Vaccarino V. Association between gender and in-hospital mortality after percutaneous coronary intervention according to age. Am J Cardiol 2003;91(8):968-71 A4. [18] Jacobs AK, Johnston JM, Haviland A, et al. Improved outcomes for women undergoing contemporary percutaneous coronary intervention: a report from the National Heart, Lung, and Blood Institute Dynamic registry. J Am Coll Cardiol 2002;39(10):1608-14. [19] Welty FK, Lewis SM, Kowalker W, Shubrooks Jr SJ. Reasons for higher in-hospital mortality N 24 hours after percutaneous transluminal coronary angioplasty in women compared with men. Am J Cardiol 2001;88(5):473-7. [20] Lima VC, Mattos LA, Caramori PR, et al. Expert consensus (SBC/ SBHCI) on the use of drug-eluting stents: recommendations of the Brazilian society of interventional cardiology/Brazilian society of cardiology for the Brazilian public single healthcare system. Arq Bras Cardiol 2006;87(4):e162-7. [21] Barlis P, Di Mario C. Still a future for the bare metal stent? Int J Cardiol 2007;121:1-3.
Annals of Vascular Surgery, 2004
There are only a few published studies on the association between subclavian steal syndrome and ischemic heart disease. The objective of this report is to evaluate the efficacy of subclavian stenoocclusion treatment in patients with subclavian steal syndrome (SSS) and previous coronary bypass. Over the last 8 years we observed 207 patients who underwent left internal mammary artery-intraventricular artery (LIMA-IVA) bypass graft. Of these, 31 patients were affected by steno-occlusion of the homolateral subclavian artery. Ten patients (group 1) showed latent vertebral-SSS and were pharmacologically treated. Seven patients (group 2) had an intermittent vertebral-SSS; four patients were treated with angioplasty and stent application and three were pharmacologically treated. Fourteen patients (group 3) with complete vertebral-SSS were treated with angioplasty and stent application or carotid-subclavian bypass graft. All patients were followed up every 3 months for a period of 5 years after the diagnosis. The first group of patients showed no angina and no sign of subclavian restenosis. In the second group only two patients, who were affected by angina, showed subclavian restenosis at angiography. In the third group only one patient underwent further angioplasty for restenosis. The results of this study show that the SSS may be an adverse event in patients with a LIMA-IVA bypass graft. Identification of the steal is essential to choose an appropriate therapeutic approach.