Related Experiment Video

Updated: Jun 3, 2026

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
05:26

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction

Published on: May 28, 2019

Coronary ischemia due to subclavian stenosis after arterial revascularization

Carlo Zebele1, H Ibrahim Ozdemir, Mohamed A Soliman Hamad

  • 1Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands. aasmsn@cze.nl

Asian Cardiovascular & Thoracic Annals
|April 8, 2011
PubMed

Insights

Coronary-subclavian steal syndrome occurred 16 years after bypass surgery due to left subclavian artery stenosis. A reoperation successfully restored blood flow, resolving coronary ischemia.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Coronary artery bypass grafting (CABG) using internal thoracic artery (ITA) grafts is a standard procedure.
  • Long-term complications of CABG can include graft failure or issues related to adjacent vasculature.
  • Coronary-subclavian steal syndrome (CSSS) is a rare complication affecting arterial grafts.

Observation:

  • A 60-year-old male presented with progressive ischemic symptoms 16 years post-CABG.
  • The patient had undergone CABG with bilateral in-situ internal thoracic artery grafts.
  • Angiography demonstrated patent arterial grafts but significant stenosis of the left subclavian artery.

Findings:

  • The patient exhibited symptoms consistent with coronary-subclavian steal syndrome.
  • The underlying cause was identified as subtotal stenosis of the left subclavian artery, compromising flow to the left internal thoracic artery graft.
  • Surgical intervention involved a reoperation using a vein graft to bypass the disrupted proximal left internal thoracic artery.

Implications:

  • Successful revascularization resolved the coronary ischemia, highlighting the importance of recognizing and treating CSSS.
  • This case underscores the potential for late complications even with widely patent arterial grafts.
  • Management strategies for CSSS may involve revascularization of the affected subclavian artery or bypass grafting to the compromised ITA.

Related Concept Videos

Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Acute Coronary Syndrome V: Nursing Management01:26

Acute Coronary Syndrome V: Nursing Management

Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
Angina II: Classification01:27

Angina II: Classification

Angina, also known as angina pectoris, is a chest pain resulting from diminished blood flow to the heart muscle and is often a symptom of coronary artery disease. Angina presents several variants with distinctive attributes, etiologies, and therapeutic approaches. The main types of angina include stable, unstable, variant (Prinzmetal's), microvascular, intractable, and silent ischemia.Stable angina is caused by atherosclerosis, which leads to the formation of plaques that narrow the coronary...