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Coronary-subclavian steal corrected with percutaneous transluminal angioplasty
1Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan.
Insights
Coronary-subclavian steal syndrome, a rare complication of bypass surgery, can cause exertional angina. Percutaneous transluminal angioplasty effectively restored blood flow and resolved symptoms in a recent case.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery bypass grafting (CABG) can rarely lead to complications such as coronary-subclavian steal syndrome.
- This syndrome involves retrograde flow in a bypass graft supplying the vertebral or internal mammary artery, stealing blood flow from the brain or heart.
Observation:
- A 58-year-old female with a history of two prior CABG procedures presented with exertional angina, left shoulder/arm pain, tinnitus, and dizziness.
- Angiography identified severe ostial stenosis of the left subclavian artery with retrograde flow via the left vertebral artery and left internal mammary artery graft.
Findings:
- Percutaneous transluminal angioplasty (PTA) was performed to address the left subclavian artery stenosis.
- Successful angioplasty restored antegrade flow to the vertebral artery and left internal mammary artery.
Implications:
- PTA is a viable and effective treatment for coronary-subclavian steal syndrome.
- Restoration of normal arterial flow led to complete resolution of the patient's debilitating symptoms, highlighting the importance of diagnosing and treating this rare complication.
Abstract:
We describe a case of coronary-subclavian steal syndrome treated with percutaneous transluminal angioplasty. A 58-year-old female who had her first coronary bypass operation 6 years previously and a second operation 3 years previously involving the left internal mammary artery and right gastroepiploic artery, developed unusual angina on effort characterized by left precordial pain, pain in the left shoulder and arm, tinnitus and dizziness. Angiography revealed retrograde flow to the left subclavian artery via the left vertebral artery and left internal mammary artery. Severe stenosis of the left subclavian artery was demonstrated at its ostium. Restoration of antegrade flow to the vertebral artery and left internal mammary artery by transluminal angioplasty resulted in complete resolution of these symptoms.