Subclavian artery occlusion causing acute myocardial infarction in a patient with a left internal mammary artery graft

Abstract

Although atherosclerotic disease of the subclavian artery has previously been reported to cause coronary-subclavian steal syndrome, acute myocardial infarction because of occlusion of the subclavian artery in a graft-dependent coronary circulation is an uncommon and previously unreported mode of clinical presentation. Increasingly, patients undergoing high-risk cardiopulmonary procedures have comorbidities with extensive atherosclerotic disease of many vascular beds including coronary, cranial, and peripheral. Our discussion reviews the clinical presentation of such a case and highlights some of the important treatment options available when confronted with such a finding. The successful outcome achieved by percutaneous stenting of the subclavian artery and salvage of the graft may indicate that this modality is the initial treatment of choice in such cases.

Management of Coronary Artery Disease in Patients With Descending Thoracic Aortic Aneurysms

“…Compromises to coronary circulation and fatal events from coronary bypass with use of left ITA have been reported when disease extends to the left subclavian artery . Thus we tend to avoid use of the left ITA when descending aneurysms are in close proximity to the left subclavian artery.…”

Coronary Subclavian Steal Syndrome Causing Acute Myocardial Infarction in a Patient Undergoing Coronary-Artery Bypass Grafting

“…Atherosclerosis is the most common cause of the steal syndrome (95%–97%) [1, 7]. Takayasu's arteritis, congenital aortic abnormalities, and thoracic outlet syndrome have also been described as possible causes in various reports [7–9].…”

“…Acute myocardial infarction (AMI), caused by this entity, is very rare. Only four reports were found in the literature [1–4]. …”

Technical Strategy in a Patient with Symptomatic Thoracic Aneurysm Near the Origin of the Left Subclavian Artery and Left Internal Thoracic Artery Coronary Graft

“…Devices are typically placed over the LSA origin, which can result in spinal cord, arm, and vertebrobasilar ischemia, anterior circulation stroke, and even death 1, 2 . Barlis et al 5 reported a case of thrombotic occlusion of the LSA ostium in a patient with an LITA graft with consequent acute myocardial infarction. A similar case of acute occlusion of the LSA during physical training was presented by Munk et al 6 In our case, because of the aneurysm configuration, the proximal landing zone may have included the LSA, and coverage might lead to coronary ischemia.…”