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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

Myocardial perfusion imaging demonstrating a moderate size area of ischemia in the mid to apical anteroseptal, apical, and periapical segments.
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fig6: Myocardial perfusion imaging demonstrating a moderate size area of ischemia in the mid to apical anteroseptal, apical, and periapical segments.

Mentions: We subsequently referred the patient for stress testing with myocardial perfusion imaging (MPI) for further risk stratification and to determine how large and severe an area of ischemia may be present from compromise of his LIMA graft. The patient exercised to 84% of his age predicted maximum heart rate and an exercise capacity of 7 METS on a standard Bruce treadmill protocol with no ECG changes, no chest pain, no arrhythmias, and normal blood pressure response to exercise. MPI showed a moderate size area of ischemia involving the mid to apical anteroseptal, apical, and periapical segments with a normal left ventricular ejection fraction of 63% (Figure 6).


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)

Myocardial perfusion imaging demonstrating a moderate size area of ischemia in the mid to apical anteroseptal, apical, and periapical segments.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig6: Myocardial perfusion imaging demonstrating a moderate size area of ischemia in the mid to apical anteroseptal, apical, and periapical segments.
Mentions: We subsequently referred the patient for stress testing with myocardial perfusion imaging (MPI) for further risk stratification and to determine how large and severe an area of ischemia may be present from compromise of his LIMA graft. The patient exercised to 84% of his age predicted maximum heart rate and an exercise capacity of 7 METS on a standard Bruce treadmill protocol with no ECG changes, no chest pain, no arrhythmias, and normal blood pressure response to exercise. MPI showed a moderate size area of ischemia involving the mid to apical anteroseptal, apical, and periapical segments with a normal left ventricular ejection fraction of 63% (Figure 6).

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