Acute myocardial ischemia in a patient with coronary-subclavian steal syndrome treated by retrograde percutaneous recanalization of the chronic total occlusion of the left subclavian artery (original) (raw)
Related papers
Coronary-Subclavian Steal Syndrome: Percutaneous Approach
Case Reports in Cardiology, 2013
Coronary subclavian steal syndrome is a rare ischemic cause in patients after myocardial revascularization surgery. Subclavian artery stenosis or compression proximal to the internal mammary artery graft is the underlying cause. The authors present a clinical case of a patient with previous history of non-ST elevation myocardial infarction, triple coronary bypass, and effort angina since the surgery, with a positive ischemic test. Coronary angiography revealed a significant stenosis of the left subclavian artery, proximal to the internal mammary graft.
Coronary-subclavian steal syndrome treated with carotid to subclavian artery by-pass
Chirurgia (Bucharest, Romania : 1990)
Coronary-subclavian steal syndrome is a rare clinical entity, which results from the atherosclerotic disease of the origin of the subclavian artery in patients in which the internal mammary artery was used as a conduit for coronary artery by-pass. This complication causes reversal of the flow in the internal mammary artery and the recurrence of myocardial ischemia. The therapeutic options are angioplasty and stent of the subclavian artery or, in a rare case of occlusion, surgical treatment. This case report describes the use of the carotid to subclavian artery by-pass for the treatment of coronary-subclavian steal syndrome due to the occlusion of the subclavian artery.
Coronary-subclavian steal syndrome. A case report
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2005
Coronary-subclavian steal is an unusual clinical syndrome after successful internal mammary-coronary artery bypass grafting. Proximal subclavian artery (SA) stenosis is present and atherosclerotic disease is the underlying pathophysiologic mechanism in the majority of cases. The authors report a case of a sixty-two-year old man with angina and ventricular fibrillation soon after myocardial revascularization with left internal mammary artery (LIMA) to left anterior descending coronary (LAD). Dobutamine stress echocardiography showed ischemia in the anterior myocardial territory with patent LIMA-LAD bypass in the angiographic evaluation. This procedure showed occlusion of the proximal SA with reversal of flow in the LIMA. The best therapeutic approach was discussed and a carotid-subclavian bypass was performed with restoration of antegrade blood flow and reversal of the clinical setting.
Diagnostic Pitfalls in Atypical Coronary-subclavian Steal Syndrome
EJVES Extra, 2005
We present a case of a 63-year-old patient with crescendo angina 12 years after coronary artery bypass graft surgery. Angiography demonstrated coronary-subclavian steal caused by severe left subclavian artery stenosis with collateral flow from an anomalous left vertebral artery, arising from the aorta. We discuss the unique angiographic features of this atypical case of coronary-subclavian steal syndrome along with its treatment.
A Case of Recurrent Coronary Subclavian Steal Syndrome
Cureus
Coronary subclavian steal syndrome (CSSS) is one of the rare complications of coronary artery bypass graft surgery (CABG). This phenomenon is a potential complication after left internal mammary artery (LIMA) to left anterior descending artery (LAD) CABG. A proximal stenosis of the left subclavian artery (SA) could cause retrograde flow from LIMA to left SA, which characterizes the mechanism of CSSS. We describe a unique case of recurrent CSSS in a 64year-old female who presented with one month of exertional dyspnea and acute onset chest pain. She had an extensive coronary artery disease history with CABG 15 years prior to presentation and CSSS treated with left SA stent placement nine years later. She also underwent percutaneous intervention with stents placed in the saphenous vein graft. Although electrocardiogram, cardiac enzymes, and stress test did not show any evidence of acute ischemic changes, perfusion scan detected large areas of partially reversible ischemia. Cardiac catheterization was performed, which showed in-stent restenosis of the left SA and retrograde flow from the LIMA to the left SA indicative of recurrence of CSSS. Left SA arteriogram confirmed in-stent restenosis of the left SA, which was treated with balloon angioplasty and stent placement.
Unstable Angina as a Result of Coronary-Subclavian Steal Syndrome
Circulation: Cardiovascular Interventions, 2008
A 75-year-old man was transferred to our department from the local hospital because of recurrent episodes of dyspnea and angina at rest, with significant 3.0-mV STsegment depressions in ECG leads V 3 through V 6 . His medical history was significant for coronary artery disease, 2-vessel coronary artery bypass grafts (1999), nondisabling stroke , type 2 diabetes mellitus, hypertension, and peripheral vascular disease. The patient also complained of dizziness and weakness of the left hand. Clinical examination was characterized by lack of radial pulse, and blood pressure could not be measured on the left arm. The echocardiogram showed apex and inferior wall hypokinesis with slightly diminished ejection fraction (50%).
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.
Coronary-Subclavian Steal: A Cause of Recurrent Myocardial Ischemia
Annals of Vascular Surgery, 1993
Coronary-subclavian steal through an internal mammary artery (IMA) graft is a rare cause of myocardial ischemia in patients who have previously undergone coronary artery bypass surgery. Two patients presented with upper extremity ischemic symptoms and recurrent angina pectoris 3 to 4 years following coronary artery bypass with in situ IMA grafts. Diagnosis of coronary-subclavian steal was confirmed by brachiocephalic arteriography, which showed tight stenosis or occlusion of the proximal subclavian artery. Coronary arteriography showed retrograde filling of the IMA with steal from the coronary circulation. Both patients were successfully treated by carotid-subclavian bypass.
Case Reports in Vascular Medicine, 2012
Purpose. Coronary-subclavian steal syndrome (CSSS) is defined as a reversal of flow in a previously constructed internal mammary artery (IMA) coronary conduit, producing myocardial ischemia. We present a case of CSSS which could not be ameliorated with endovascular therapy and necessitated a subclavian-subclavian bypass.Case Report. 80-year-old Caucasian male with history of CABG presented with syncope. He had absent left-sided radial pulse with blood pressure being 60/40 on left arm and 130/80 on the right. He underwent cardiac catheterization for NSTEMI which showed patent left internal mammary artery graft to left anterior descending coronary artery with retrograde flow, and diagnosis of coronary subclavian steal syndrome was made. Complete occlusion of proximal left subclavian artery was identified. Percutaneous angioplasty failed because of calcified plaque causing 100% occlusion. Carotid doppler showed bilateral carotid artery disease. He finally underwent subclavian-subclavia...
Case Reports in Cardiology, 2014
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.