Stenting for Left Subclavian Artery Stenosis before and after Coronary Artery Bypass Grafting Using the Internal Mammary Artery

Chokyu, Isao; Terada, Takafumi; Matsuda, Y.; Okumura, Hidemasa; Shintani, Akira; Nakamura, Yusuke; Ohura, Yoshinori; Tsumoto, Tomoyuki; Masuo, Osamu; Matsumoto, Hiroyuki; Itakura, Toru

doi:10.1177/159101990801400214

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…With an incidence between 0.5% and 2% of patients undergoing coronary artery bypass grafting [ 1 ] , the CSSS was initially described by Hargola / Valle and Tyras / Barner in the 70s, concurrently with the beginning of the use of the internal mammary artery as a conduit artery [ 2 ] . The use of this artery is widely accepted because of its high long-term patency rate and low atherosclerosis, being used in most Coronary artery bypasses [ 3 - 6 ] .…”

Section: Discussionmentioning

confidence: 99%

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Left Subclavian Artery Stenting: an option for the treatment of the Coronary-Subclavian Steal Syndrome

Almeida¹,

Kambara²,

Rossi³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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Introduction The subclavian steal syndrome is characterized by the vertebral artery flow inversion, due to a stenotic lesion in the origin of the subclavian artery. The Coronary-subclavian Steal Syndrome is a variation of the Subclavian Steal Syndrome and is characterized by inversion of flow in the Internal Thracic artery that has been used as conduct in a myocardial revascularization. Its diagnosis must be suspected in patients with difference in pulse and arterial pressure in the upper limbs, that present with angina pectoris and that have done a myocardial revascularization. Its treatment must be a surgical bypass or a transluminal angioplasty. Objective The objective is to show the left subclavian artery stenting as a safe and effective method to treat the coronary-subclavian steal syndrome. Methods Historical prospective, non-randomized trial, through revision of the hospital records of the patients treated with the stenting of the left subclavian artery, from January 2006 to September 2012. Results In the mentioned period, 4.291 miocardial revascularizations were performed with the use of the left mammary artery, and 16 patients were identified to have the Coronary-subclavian steal syndrome. All of them were submitted to endovascular treatment. The success rate was 100%; two patients experienced minor complications; none of them presented with major complications. Eleven of the 16 patients had ultrassonographic documentation of patent stent for at least one year; two patients lost follow up and other two died. Conclusion The stenting of the left subclavian artery is a good option for the treatment of the Coronary-subclavian Steal Syndrome, with high level of technical and clinical success.

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Section: Discussionmentioning

confidence: 99%

“…Other causes include Takayasu arteritis, actinic arteritis and giant cell arteritis [ 1 ] . The occlusion of the proximal subclavian artery causes flow reversal in arteries downstream (vertebral and internal mammary), leading to several vertebral- basilary symptoms (dizziness, nystagmus, nausea) and myocardial ischemia [ 2 ] .…”

Section: Discussionmentioning

confidence: 99%

Left Subclavian Artery Stenting: an option for the treatment of the Coronary-Subclavian Steal Syndrome

Almeida¹,

Kambara²,

Rossi³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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“…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].…”

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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“…If the stenosis becomes critical or an acute occlusion occurs in the subclavian artery, this may result in myocardial infarction [ 1 ]. Many cases were reported about these phenomenon and stenting of subclavian artery results in improvement of ischemia [ 1 , 5 – 8 ]. In all of these cases the coronary anatomy through CABG was reported to be mainly unaffected and no support left ventricle devises were needed.…”

Section: Discussionmentioning

confidence: 99%

High-Risk Acute Coronary Syndrome in a Patient with Coronary Subclavian Steal Syndrome Secondary to Critical Subclavian Artery Stenosis

Fanari

Abraham

Hammami

et al. 2014

Case Reports in Cardiology

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Patients with multivessel coronary artery disease are more likely to have extensive atherosclerosis that involves other major arteries. Critical subclavian artery (SCA) stenosis can result in coronary subclavian steal syndrome that may present as recurrent ischemia and even myocardial infarction in patients with coronary artery bypass graft (CABG). In patients with concomitant severe native coronary disease, occluded saphenous venous grafts (SVG) to other arteries, percutaneous intervention on critical subclavian artery (SCA) stenosis that will compromise the blood flow to left internal mammary graft (LIMA) and left anterior descending (LAD) artery will be a high-risk procedure and may be associated with cardiogenic shock, especially in patients with preexisting ischemic cardiomyopathy. The use of percutaneous left ventricular (LV) assist device like Impella will offer better hemodynamic support and coronary perfusion and therefore results in decreased myocardial damage, maximized residual cardiac function, and lower incidence of cardiogenic shock.

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Stenting for Left Subclavian Artery Stenosis before and after Coronary Artery Bypass Grafting Using the Internal Mammary Artery

Cited by 7 publications

References 9 publications

Left Subclavian Artery Stenting: an option for the treatment of the Coronary-Subclavian Steal Syndrome

Left Subclavian Artery Stenting: an option for the treatment of the Coronary-Subclavian Steal Syndrome

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

High-Risk Acute Coronary Syndrome in a Patient with Coronary Subclavian Steal Syndrome Secondary to Critical Subclavian Artery Stenosis

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