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

Younus U, Abbott B, Narasimha D, Page BJ - Case Rep Cardiol (2014)

Bottom Line: Subclavian angiography was performed with an attempt to revascularize the patient's occluded left SA which was unsuccessful.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

Thoracic aortogram with supra-aortic vessels. (A) Complete SA occlusion.
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fig3: Thoracic aortogram with supra-aortic vessels. (A) Complete SA occlusion.

Mentions: At the recommendation of the vascular surgery consultant, subclavian angiography was performed with a view towards percutaneous intervention. This confirmed complete occlusion of left SA with severe calcification just distal to its origin (Figures 3 and 4) and reconstitution of the SA at the level of the vertebral artery through collaterals from the carotid artery to the vertebral artery. The Distal SA was perfused by retrograde blood flow from the vertebral artery (Figure 5). Attempts to pass the guide wire across the lesion were unsuccessful (Figure 4), and the left SA could not be percutaneously revascularized.


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

Younus U, Abbott B, Narasimha D, Page BJ - Case Rep Cardiol (2014)

Thoracic aortogram with supra-aortic vessels. (A) Complete SA occlusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4020528&req=5

fig3: Thoracic aortogram with supra-aortic vessels. (A) Complete SA occlusion.
Mentions: At the recommendation of the vascular surgery consultant, subclavian angiography was performed with a view towards percutaneous intervention. This confirmed complete occlusion of left SA with severe calcification just distal to its origin (Figures 3 and 4) and reconstitution of the SA at the level of the vertebral artery through collaterals from the carotid artery to the vertebral artery. The Distal SA was perfused by retrograde blood flow from the vertebral artery (Figure 5). Attempts to pass the guide wire across the lesion were unsuccessful (Figure 4), and the left SA could not be percutaneously revascularized.

Bottom Line: Subclavian angiography was performed with an attempt to revascularize the patient's occluded left SA which was unsuccessful.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus