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'Cold hand, ischemic heart': treatment by stenting of the left subclavian artery

S Osula1, N M Gandhi, M Chester

  • 1The Cardiothoracic Centre N Liverpool, Thomas Drive, Liverpool, L14 3PE, United Kingdom. Serge.Osula@ccl-tr.nwest.nhs.uk

The Journal of Invasive Cardiology
|November 4, 2000
PubMed

Insights

A patient experienced angina and a cold hand eight years after bypass surgery. Treating left subclavian artery stenosis with angioplasty and stenting relieved symptoms and improved angina.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
  • Graft failure and progression of atherosclerosis can lead to recurrent symptoms years after CABG.
  • Subclavian artery stenosis can compromise flow to the internal mammary artery (IMA) grafts.

Observation:

  • A 59-year-old male presented with worsening angina and a cold, painful left hand.
  • Coronary angiography revealed extensive coronary atherosclerosis and blocked vein grafts.
  • Severe stenosis was noted in the left subclavian artery proximal to a patent left internal mammary artery (LIMA) graft.

Findings:

  • Percutaneous transluminal coronary angioplasty (PTCA) and stenting of the left subclavian artery stenosis were performed.
  • The procedure successfully restored blood flow to the left hand and the LIMA graft.
  • The patient experienced complete resolution of ischemic hand symptoms and significant improvement in angina.

Implications:

  • Percutaneous intervention for subclavian artery stenosis is a viable treatment option in patients with coronary artery disease.
  • Restoring flow through the LIMA graft can alleviate peripheral ischemic symptoms and improve angina.
  • This case highlights the importance of evaluating the entire arterial supply, including non-coronary targets, in patients with recurrent ischemic symptoms post-CABG.

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