Coronary Subclavian Steal Syndrome in a 73-Year-Old Woman Presenting with Angiographically Confirmed Subclavian Artery Stenosis Proximal to the Left Internal Mammary

Abstract

Patient: Female, 73-year-old Final Diagnosis: Coronary subclavian steal syndrome Symptoms: Arrhythmia • dyspnea Medication: — Clinical Procedure: Stenting Specialty: Cardiology Objective: Rare coexistence of disease or pathology Background: Coronary subclavian steal syndrome (CSSS) is an uncommon condition in which a high-grade stenosis of the subclavian artery proximal to an internal mammary artery bypass graft results in retrograde blood flow of the bypass graft. This report is of CSSS in a 73-year-old woman who presented with ventricular tachycardia and angiographically confirmed subclavian artery stenosis proximal to the left internal mammary artery (LIMA) bypass graft 3 years following coronary artery bypass grafting (CABG). Case Report: The patient was a 73-year-old woman with a past medical history of multivessel coronary artery disease, found on preoperative evaluation. She underwent 2 vessel CABG in 2018. She was found to have ischemic cardiomyopathy, ejection fraction of 30% to 35% despite revascularization, and an implantable cardiac defibrillator (ICD). Three years following uncomplicated CABG, the patient presented with angina and sustained ventricular tachycardia; ICD therapy was unsuccessful. Ischemia was the etiology of the sustained ventricular tachycardia, and the patient underwent cardiac catheterization, demonstrating high-grade subclavian artery stenosis proximal to the LIMA bypass graft. Intervention of the 80% lesion of the native left anterior descending artery was done with placement of a 2.75×16-mm drug-eluting stent. The patient responded well to treatment, with no subsequent ventricular tachycardia on outpatient follow-up. Conclusions: This report has shown that in patients who present with symptoms of acute coronary syndrome and a history of CABG involving the LIMA, the possibility of CSSS should be considered and investigated by coronary artery imaging so that diagnosis and management are not delayed.

Anesthetic management of a patient with bilateral subclavian artery stenosis undergoing lower extremity arterial thrombectomy

“…These ndings indicate the presence of myocardial ischemia and associated structural changes, potentially linked to subclavian artery stenosis. Typically, the proximal end of the left internal mammary artery (LIMA) connects to the left subclavian artery [13] . After resection, its distal end is anastomosed to the compromised epicardial coronary artery.…”