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Published on: September 15, 2023
Left Subclavian Artery Thrombosis Causing Myocardial Ischemia in Patients With Prior Coronary Artery Bypass Grafting
Omar Toubat1, Ryan A Watson2, Russell D Rosenberg3
1Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Acute subclavian artery thrombosis can cause myocardial ischemia in patients with left internal mammary artery (LIMA) grafts. Covered stent placement successfully restored flow and resolved symptoms in two cases.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Acute subclavian artery thrombosis is an uncommon cause of myocardial ischemia.
- This complication is particularly rare in patients with prior coronary artery bypass grafting, especially those with left internal mammary artery (LIMA) grafts.
Background:
Acute subclavian artery thrombosis is a rare cause of myocardial ischemia in patients with prior coronary artery bypass grafting.
Case Summary:
We present 2 cases of patients with left internal mammary artery (LIMA) to left anterior descending bypass grafts who developed cardiac ischemia secondary to acute thrombotic occlusion of the left subclavian artery. The first patient developed ventricular fibrillatory arrest after esophagectomy and the second patient had non-ST-segment elevation myocardial infarction in the setting of a recent colonoscopy. In both cases, left subclavian artery patency was reestablished following deployment of a covered stent. Antegrade flow to the LIMA to left anterior descending was restored with resolution of ischemic symptoms in both patients.
Discussion:
Acute thrombotic occlusion of the left subclavian artery is a rare cause of myocardial ischemia in patients with LIMA-dependent coronary circulation.
Take-Home Message:
Endovascular management with covered stent deployment is a feasible alternative to thrombectomy in this setting.
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