[Coronary-subclavian steal syndrome]

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Medicine

Background:

• Coronary-subclavian steal syndrome (CSSS) is a rare complication post-coronary artery bypass grafting (CABG), particularly with left internal mammary artery (LIMA) grafts.
• Atherosclerosis is the primary etiology, leading to proximal subclavian artery stenosis or occlusion, causing retrograde flow and steal phenomenon.

Observation:

• Three male patients (60-69 years) with cardiovascular risk factors presented with myocardial ischemia symptoms months to years after LIMA-to-LAD revascularization.
• Physical examination revealed diminished or absent radial pulses, and cardiac catheterization confirmed left subclavian artery disease (occlusion or >90% stenosis).

Findings:

• Endovascular stenting of the left subclavian artery was successfully performed in all three cases, achieving complete revascularization without residual stenosis.
• Post-intervention, patients experienced pulse symmetry restoration and resolution of ischemic symptoms, with one patient reporting residual non-specific chest discomfort upon exertion.

Implications:

• Endovascular revascularization is emerging as a preferred first-line treatment for CSSS, offering high patency rates and low morbidity/mortality compared to traditional surgery.
• The study highlights the efficacy of endovascular stenting for CSSS, underscoring the need for timely diagnosis and intervention to prevent myocardial ischemia.