Patent Coronary Artery Bypass Graft (CABG) is not Sufficient for Myocardial Perfusion - Non-ST Elevation Myocardial Infarction Caused by Critical Subclavian Artery Stenosis

Abstract

Myocardial revascularization using the left internal thoracic artery (LITA) has become a standard method for coronary artery bypass graft (CABG) surgery due to its long-term graft patency and lower repeated revascularization rate compared to a saphenous vein graft. The prevalence of significant subclavian artery stenosis was reported to be 0.2-6.8% in patients undergoing CABG surgery using LITA. We present a case of 49-year-old female patient who complained of resting chest pain and left arm pain after CABG surgery using the LITA. NSTEMI was caused by de novo subtotal left subclavian artery stenosis proximal to the LITA. The left subclavian artery was successfully stented, and the patient experienced complete relief of pain.

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

“…Since the first description of this entity by Harjola and Valle [5], there have been isolated case reports of CSSS. Atherosclerosis is the most common cause of stenosis (95-97%), although arteriovenous fistula, Takayasu's arteritis, congenital aortic abnormalities, and thoracic outlet syndrome have also been described as possible causes [2,6]. The presence of symptoms within the first 2 years of surgery indicates that the patient had already a relevant stenosis at the moment of CABG [7].…”

“…Prevalence varies across studies, ranging from 0.2% to 6.8% and it may be underestimated since angiographic assessment is not routinely performed in the pre-operative setting in many centers and clinical signs among patients may be absent [1,2].…”