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

Abstract

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.