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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

Left anterior oblique projection showing left coronary circulation with severe disease.
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fig7: Left anterior oblique projection showing left coronary circulation with severe disease.

Mentions: Following this result, we referred the patient for left heart catheterization to assess the extent and severity of his native coronary artery disease and to determine the feasibility of percutaneous coronary intervention (PCI) to his native LAD. Coronary angiography confirmed the patency of his bypass grafts as well as severe and diffuse native CAD with 80% left main stenosis and 80–90% proximal LAD stenosis (Figure 7); there was also evidence of intermittent retrograde filling of the LIMA from the LAD into the left SA distal to the occlusion (Figure 8).


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)

Left anterior oblique projection showing left coronary circulation with severe disease.
© Copyright Policy
Related In: Results  -  Collection

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

fig7: Left anterior oblique projection showing left coronary circulation with severe disease.
Mentions: Following this result, we referred the patient for left heart catheterization to assess the extent and severity of his native coronary artery disease and to determine the feasibility of percutaneous coronary intervention (PCI) to his native LAD. Coronary angiography confirmed the patency of his bypass grafts as well as severe and diffuse native CAD with 80% left main stenosis and 80–90% proximal LAD stenosis (Figure 7); there was also evidence of intermittent retrograde filling of the LIMA from the LAD into the left SA distal to the occlusion (Figure 8).

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