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[Coronary subclavian steal syndrome; report of a case]
1Department of Cardiovascular Surgery, Mito Saiseikai General Hospital, Mito, Japan.
Insights
Axilloaxillary artery bypass grafting effectively treated coronary subclavian steal syndrome in a patient with left subclavian artery stenosis. This surgical approach successfully resolved myocardial ischemia and prevented potential brain ischemia.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Coronary subclavian steal syndrome (CSSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery.
- Proximal left subclavian artery stenosis can lead to reduced blood flow, potentially causing ischemic symptoms.
Observation:
- A 64-year-old male presented with chest discomfort 10 years post-CABG.
- Angiography revealed CSSS and 90% stenosis in the proximal left subclavian artery.
- Carotid ultrasonography showed 75% stenosis at the left carotid artery bifurcation.
Findings:
- Axilloaxillary artery bypass grafting was performed to restore blood flow and prevent cerebral ischemia.
- Post-procedure myocardial thallium scintigraphy with dipyridamole testing showed no evidence of myocardial ischemia.
- The patient's CSSS was effectively managed by the axilloaxillary bypass.
Implications:
- Axilloaxillary artery bypass grafting is a viable and effective treatment for CSSS in the presence of significant subclavian artery stenosis.
- This surgical technique can successfully alleviate myocardial ischemia and mitigate the risk of stroke in complex vascular cases.
- The findings support considering axilloaxillary bypass as an alternative strategy when traditional revascularization options are limited or contraindicated.
Abstract:
A 64-year-old man was admitted to our hospital with chief complaint of chest discomfort. He received coronary artery bypass grafting utilizing the in situ left internal thoracic artery 10 years ago. Coronary and left subclavian artery angiogram revealed coronary subclavian steal syndrome and 90% stenosis in the proximal left subclavin artery. Ultrasonography of neck vessels demonstrated 75% stenosis in the bifurcation of left carotid artery. We performed axilloaxillary artery bypass grafting to avoid brain ischemia. Myocardial thallium scintigraphy on dipyridamole testing after axilloaxillary artery bypass grafting could not detect myocardial ischemia. Axilloaxillary artery bypass grafting was effective for coronary subclavian steal syndrome.