Coronary subclavian steal syndrome

Sintek, Marc; Coverstone, Edward; Singh, Jasvindar

doi:10.1097/hco.0000000000000109

Cited by 30 publications

(31 citation statements)

References 109 publications

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“…These surgical procedures are relatively high risk but may be the only option for revascularization in patients with a completely occluded subclavian artery. Surgical bypass has been the preferred option in circumstances where length of the lesion is > 5 cm, where there is severe calcification and complete occlusion near the ostium of the vertebral artery [9,10].…”

Section: Discussionmentioning

confidence: 99%

Coronary-Subclavian Steal Syndrome: An Infrequent Cause of Ischemia Post Coronary Artery Bypass Graft Surgery

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

Coronary-Subclavian Steal Syndrome: An Infrequent Cause of Ischemia Post Coronary Artery Bypass Graft Surgery

et al. 2017

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Section: Iglesias Et Al Coronary Subclavian Steal Syndrome and Stemi 71mentioning

confidence: 99%

“…1,3,4 Anterior ST-segment-elevation myocardial infarction resulting from an acute left SCA occlusion in patients with CSSS after CABG has been described previously. 1 We report here on a patient with unrecognized CSSS complicating previous CABG surgery with the LIMA several years earlier who presented with anterior ST-segment-elevation myocardial infarction resulting from an acute thrombotic occlusion of the native LAD at the LIMA-to-LAD anastomotic site. In our case, the patient was referred for CABG surgery without functional assessment of an angiographically intermediate ostial stenosis of the LAD, and the LIMA graft remained patent, probably as a result of the progression of an unrecognized atherosclerotic disease of the left SCA at the time of CABG, thus allowing vascularization of the left upper limb by the retrograde flow from the LAD into the left SCA.…”

Section: Iglesias Et Al Coronary Subclavian Steal Syndrome and Stemi 71mentioning

confidence: 99%

mentioning

confidence: 99%

“…[1][2][3] CSSS results from the retrograde blood flow through the LIMA graft in the left subclavian artery (SCA), consecutive to a proximal SCA stenosis or total occlusion. CSSS usually manifests as stable angina pectoris 1 but also rarely presents as ST-segment-elevation myocardial infarction secondary to an acute SCA occlusion or plaque rupture. 1,2 Anterior ST-segment-elevation myocardial infarction resulting from an acute thrombotic occlusion of the left anterior descending (LAD) artery at the LIMA-to-LAD anastomotic site in a patient with concomitant CSSS may be a challenging problem during primary percutaneous coronary intervention and has not been reported to date.…”

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Coronary Subclavian Steal Syndrome and Acute Anterior Myocardial Infarction

et al. 2015

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C oronary subclavian steal syndrome (CSSS) is an uncommon complication after coronary artery bypass graft (CABG) surgery using the left internal mammary artery (LIMA). 1-3 CSSS results from the retrograde blood flow through the LIMA graft in the left subclavian artery (SCA), consecutive to a proximal SCA stenosis or total occlusion. CSSS usually manifests as stable angina pectoris 1 but also rarely presents as ST-segment-elevation myocardial infarc-tion secondary to an acute SCA occlusion or plaque rupture. 1,2 Anterior ST-segment-elevation myocardial infarction resulting from an acute thrombotic occlusion of the left anterior descending (LAD) artery at the LIMA-to-LAD anastomotic site in a patient with concomitant CSSS may be a challenging problem during primary percutaneous coronary intervention and has not been reported to date. Here, we report on a 62-year-old woman with hypertension, dyslipidemia, and peripheral artery disease who underwent CABG surgery using a LIMA graft to the LAD 12 years earlier (Figure 1 and Movie I in the online-only Data Supplement). The patient presented to the emergency department with de novo exertional chest pain. The 12-lead ECG showed negative T waves in the anterior leads, and her cardiac biomarkers were normal. During admission, the patient developed chest pain at rest associated with paresthesias of the left hand. An ECG showed new anterior ST-segment elevation, and the patient was transferred for primary percutaneous coronary intervention. The left coronary angiogram (Movie II in the online-only Data Supplement) showed a patent LAD with critical stenosis at the site of the LIMA-to-LAD anastomosis (Figure 1) and an unexpected retrograde flow through the patent LIMA graft to the left SCA (Figure 1). Interestingly, no angiographically significant stenosis was visualized on the proximal native LAD. An angiogram of the aortic root revealed total occlusion at the origin of the left SCA (Figure 1 and Movie III in the online-only Data Supplement), which, combined with the retrograde flow through the LIMA, confirmed the presence of CSSS with vascularization of the left upper limb depending on the reversed flow through the LIMA graft. Primary percutaneous coronary intervention to the LAD was performed with a drug-eluting stent across the LIMA-to-LAD anastomotic site. The final coronary angiogram (Movie IV in the online-only Data Supplement) demonstrated a restored anterograde flow from the proximal to the distal LAD and a preserved retrograde flow through the LIMA graft to the left SCA (Figure 1). Physical examination revealed a weaker left radial pulse, but plethys-mography confirmed a biphasic pulse wave at the level of the left upper limb. An urgent Doppler ultrasonography showed occlusion of the left SCA and CSSS with reversed flow in the LIMA and anterograde flow in the left vertebral artery. No critical left upper-limb ischemia was documented, and conservative management was suggested. Computed tomographic angiography demonstrated a 15-mm total occlusion at the origin of the le...

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