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Simultaneous coronary - subclavian and vertebral - subclavian steal syndrome
Sang Rok Lee1, Myung Ho Jeong, Jay Young Rhew
1The Heart Center, Chonnam National University Hospital and Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
Insights
Coronary artery disease can affect the subclavian artery, causing myocardial ischemia via coronary steal. Isometric exercise may improve blood flow through vertebral-subclavian steal, benefiting patients with coronary artery bypass grafts.
Area of Science:
- Cardiology
- Vascular Surgery
- Neurology
Background:
- Coronary artery atherosclerosis can involve the subclavian artery, potentially leading to myocardial ischemia.
- Patent left internal mammary artery (LIMA) grafts can be susceptible to 'coronary steal' in cases of left subclavian artery stenosis.
- Vertebral-subclavian steal phenomenon can influence cerebral and myocardial perfusion.
Observation:
- A patient presented with coronary steal through a LIMA graft post-coronary artery bypass surgery.
- The patient also exhibited transient vertebral-subclavian steal.
- Isometric exercise of the left arm was performed by the patient.
Findings:
- Isometric exercise of the left arm improved myocardial perfusion in the patient.
- This improvement was attributed to a transient vertebral-subclavian steal phenomenon.
- The exercise altered the pressure gradient between the circle of Willis and the distal subclavian artery, causing flow reversal in the vertebral artery.
Implications:
- Understanding the interplay between coronary and subclavian artery disease is crucial for managing myocardial ischemia.
- The 'coronary steal' phenomenon through LIMA grafts can be exacerbated by subclavian stenosis.
- Therapeutic strategies involving isometric exercise may offer a non-invasive approach to improve myocardial perfusion in select patients with complex vascular conditions.
Abstract:
Atherosclerotic disease of the coronary artery may simultaneously involve the subclavian artery, and a significant stenosis of the left subclavian artery may result in recurrent myocardial ischemia in patients with patent left internal mammary artery (LIMA) grafts because of 'coronary steal' through the LIMA. Isometric exercise of the left arm may improve myocardial perfusion through vertebral - subclavian steal by flow reversal in the ipsilateral vertebral artery because of the change in the pressure gradient between the circle of Willis and the distal subclavian artery. The present patient had coronary steal through a LIMA after coronary artery bypass surgery and a transient vertebral - subclavian steal with improved myocardial perfusion as a result of exercise of the left arm.