Restenting for subclavian in-stent restenosis with symptomatic recurrent coronary-subclavian steal

To determine whether restenting for recurrent coronary-subclavian syndrome is technically feasible, provides durable results, and is a reasonable alternative to surgery.

A 58-year-old woman with a left internal mammary artery (LIMA) bypass to the left anterior descending artery underwent angioplasty and stent placement for left subclavian stenosis and coronary-subclavian steal. Twenty-three months later, she returned with progressive angina and left arm claudication; heart catheterization demonstrated restenosis of the subclavian artery at the stent site with recurrence of the coronary-subclavian steal. Successful redo angioplasty and stenting resulted in normal antegrade flow through the LIMA graft. The patient has remained asymptomatic for 3 years without evidence of recurrent in-stent stenosis on serial noninvasive studies.

Restenting is technically feasible and appears to be a durable response to subclavian in-stent restenosis in patients with coronary subclavian steal.