Subclavian atherectomy and angioplasty for coronary subclavian steal syndrome post CABG

Gill, Harkanwar; Gill, Harman S.; Kotha, V.

doi:10.1016/j.radcr.2022.02.032

Radiology Case Reports

2022

DOI: 10.1016/j.radcr.2022.02.032

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Subclavian atherectomy and angioplasty for coronary subclavian steal syndrome post CABG

Harkanwar Gill

Harman S. Gill

V. Kotha

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2024

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Cited by 2 publications

References 14 publications

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Effects of percutaneous endovascular angioplasty for severe stenosis or occlusion of subclavian artery

Zhao,

Xu,

Xue

et al. 2024

Sci Rep

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To investigate the effect and safety of percutaneous endovascular angioplasty (PEA) with optional stenting for the treatment of severe stenosis or occlusion of subclavian artery, patients with severe stenosis ≥ 70% or occlusion of subclavian artery treated with PEA were retrospectively enrolled. The clinical data were analyzed. A total of 222 patients were retrospectively enrolled, including 151 males (68.0%) and 71 females (32.0%) aged 48–86 (mean 63.9 ± 9.0) years. Forty-seven (21.2%) patients had comorbidities. Subclavian artery stenosis ≥ 70% was present in 201 (90.5%) patients and complete subclavian occlusion in 21 (9.5%) cases. Angioplasty was successfully performed in all (100%) patients. Balloon-expandable stents were used in 190 (85.6%) cases, and self-expandable stents in 20 (9.0%) cases. Only 12 (5.4%) cases were treated with balloon dilation only. Among 210 patients treated with stent angioplasty, 71 (33.8% or 71/210) cases underwent balloon pre-dilation, 139 (66.2% or 139/210) had direct deployment of balloon-expandable stents, and 2 (1.0% or 2/210) experienced balloon post-dilation. Distal embolization protection devices were used in 5 (2.3% or 5/222) cases. Periprocedural complications occurred in 3 (1.4%) patients, including aortic dissection in 2 (0.9%) cases and right middle cerebral artery embolism in 1 (0.5%). No hemorrhage occurred. Among 182 (82.0%) patients with 6-month follow-up, restenosis > 70% occurred in 1 (0.5%) patient, and among 68 (30.6%) patients with 12-month follow-up, restenosis > 70% took place in 11 (16.2%) patients. Percutaneous endovascular angioplasty can be safely and efficiently performed for the treatment of severe stenosis ≥ 70% or occlusion of subclavian artery.

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Effects of percutaneous endovascular angioplasty for severe stenosis or occlusion of subclavian artery

Zhao,

Xu,

Xue

et al. 2024

Sci Rep

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Subclavian coronary steal syndrome in a post coronary artery bypass grafting patient: A case report

Parikh¹,

Shah²,

Shah³

et al. 2023

HVT

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Objective: "Subclavian coronary steal" refers to diversion of blood flow from coronary bed to subclavian artery. In patients receiving internal mammary grafts during coronary artery bypass grafting surgery (CABG), aorta and its proximal branches become part of coronary circulation. Atherosclerotic occlusion of subclavian artery can manifest as subclavian coronary steal syndrome and patients may present with angina, myocardial infarction and even sudden cardiac death. The objective of our case report is to identify and present important non-conventional causes of angina for better management of patients. Case presentation: A 50-year-old, hypertensive, male patient with a prior history of having undergone CABG, presented with CCS class III angina of one-month duration. He was found to have a completely occluded left subclavian artery from origin with retrograde flow of blood in left internal mammary artery from coronary to subclavian artery. Percutaneous transluminal angioplasty with stenting to subclavian artery was performed. Antegrade flow was established and coronary steal through left internal mammarian artery graft was thus abolished with subsequent resolution of symptoms. Conclusion:We have presented a case of refractory angina in post coronary artery bypass grafting patient who was eventually treated with percutaneous stent implantation to treat the subclavian stenosis; and had complete resolution of symptoms post intervention. Take home message: Patients undergoing CABG should be screened for a possible asymptomatic subclavian stenosis that may become symptomatic after CABG. Also, subclavian coronary steal syndrome should be suspected in patients presenting with refractory angina post CABG.

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Subclavian atherectomy and angioplasty for coronary subclavian steal syndrome post CABG

Cited by 2 publications

References 14 publications

Effects of percutaneous endovascular angioplasty for severe stenosis or occlusion of subclavian artery

Effects of percutaneous endovascular angioplasty for severe stenosis or occlusion of subclavian artery

Subclavian coronary steal syndrome in a post coronary artery bypass grafting patient: A case report

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