Coronary subclavian steal syndrome due to thrombosis of the left subclavian artery aneurysm: a case report (original) (raw)
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Journal of Medical Cases, 2017
Coronary-subclavian steal syndrome (CSSS) is a rare complication of coronary artery bypass graft (CABG) surgery. We describe the case of a 72-year-old male patient who presented with chest pain and hypotension 24 h after CABG surgery. The angiography showed reduced blood flow to the left anterior descending (LAD) artery and severe left proximal subclavian artery stenosis (SAS). The patient underwent successful left subclavian artery stenting. All patients considered for CABG surgery should be screened with bilateral non-invasive brachial blood pressure prior to surgical referral and differences greater than 10 mm Hg between arms warrant additional testing.
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 Syndrome following Coronary- Artery Bypass Grafting
Cardiology 1991;78:53-57 ©1991 S. Karger AG. Basel 0 0 0 8 -6 3 12 /9 1 / 0 7 8 1 -0 0 5 3 S2 .7 5 /0 Abstract. Angina pectoris resulting from the coronary-subclavian steal syndrome is a rare phenomenon with only 10 previously reported cases. However, with the increasing use of the internal mammary artery in the coronary artery bypass graft (CABG) procedure it may be encountered more frequently in the future. We report our recent experience with coronarysubclavian steal syndrome after CABG with 2 patients in whom complete relief from angina pectoris was obtained following bypass of a proximal subclavian artery occlusion in one patient and improvement of angina in the other. A review of the relevant literature is also presented.
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.
Acute peri-operative coronary subclavian steal syndrome: A diagnostic and treatment challenge
Journal of cardiology cases, 2018
The coronary subclavian steal syndrome (CSSS) generally occurs during follow up after coronary surgery. The case demonstrates an immediate peri-operative CSSS followed by myocardial infarction, notwithstanding a preoperative computed tomography scan quantifying subclavian artery calcifications as non-stenosing, and a subjective patent blood flow through the transected left internal mammary artery (LIMA). Blood flow inversion in the LIMA to anterior descending artery (LAD) bypass was detected by transit time flow measurement (TTFM). Following an elective brachiocephalic bypass a complementary, emergent subclavian bypass was performed, which restored antegrade LIMA flow, as confirmed by TTFM and angiography, but the patient suffered a peri-operative myocardial infarction. Reports about elective, concomitant subclavian and coronary surgery for sub-acute CSSS, allowing diagnostic investigations, have been published; however this case demonstrates diagnostic and treatment challenges in a...
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.
Coronary Subclavian Steal Syndrome: An Unusual Cause of Angina in a Post-CABG Patient
Case Reports in Cardiology, 2014
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 nativ...
Coronary-Subclavian Steal Syndrome Report of a Case Treated with Subclavian Angioplasty
Japanese Heart Journal, 1995
We describe the case of a man aged 42 who, five years before, had undergone aortocoronary bypass surgery using the internal mammary artery for the anterior and saphenous vein graft for the posterior descending arteries. Over the last one and a half years he had started to present angina pectoris as well as symptoms of vertebrobasilar insufficiency during exertion of the left upper extremity (recently during simple writing), whereas a full treadmill test was normal. Clinically, obstruction of the left subclavian artery was suspected with both coronary and subclavian steals. This suspicion was confirmed with triplex of the vessels of the aortic arch, coronary arteriography and carotid arteriography which demonstrated severe obstruction of the left subclavian artery at its origin and reversal of blood flow through the ipsilateral vertebral artery and the internal mammary artery graft. Angina subsided after balloon angioplasty of the subclavian artery. This combined steal, termed coronarysubclavian syndrome, is rare (our case is probably the 20th reported), but an increase of its incidence is anticipated due to the widespread use of internal mammary artery grafts. The prevention and treatment of this syndrome are discussed.
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.
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...