Atypical and rare cause of myocardial infarction: coronary subclavian steal syndrome (CSSS) treated by a carotid-subclavian bypass in a 71-year-old female patient

Walensi, Mikolaj; Bernheim, J; Ulatowski, Nikodemus; Piotrowski, M; Karaindros, Konstantinos; Juntermanns, Benjamin; Mikat, Christian; Heesen, Roland; Hoffmann, Johannes N.

doi:10.1186/s13019-021-01625-5

Cited by 3 publications

(1 citation statement)

References 16 publications

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“…In patients for whom the ostium of vertebral arteries and IMA is in close proximity to subclavian artery stenosis and plaque migration is a concern, there remains an option for surgical revascularization [ 7 ]. Plaque migration and embolization of contents can be devastating, with vertebral embolization resulting in posterior circulation stroke, and IMA embolization resulting in graft closure or myocardial infarction [ 8 , 9 ]. Medical therapy following intervention regardless of approach must be focused on management of cardiovascular comorbidities to prevent further disease progression.…”

Section: Discussionmentioning

confidence: 99%

Coronary Subclavian Steal Syndrome in a 73-Year-Old Woman Presenting with Angiographically Confirmed Subclavian Artery Stenosis Proximal to the Left Internal Mammary

2022

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Patient: Female, 73-year-old Final Diagnosis: Coronary subclavian steal syndrome Symptoms: Arrhythmia • dyspnea Medication: — Clinical Procedure: Stenting Specialty: Cardiology Objective: Rare coexistence of disease or pathology Background: Coronary subclavian steal syndrome (CSSS) is an uncommon condition in which a high-grade stenosis of the subclavian artery proximal to an internal mammary artery bypass graft results in retrograde blood flow of the bypass graft. This report is of CSSS in a 73-year-old woman who presented with ventricular tachycardia and angiographically confirmed subclavian artery stenosis proximal to the left internal mammary artery (LIMA) bypass graft 3 years following coronary artery bypass grafting (CABG). Case Report: The patient was a 73-year-old woman with a past medical history of multivessel coronary artery disease, found on preoperative evaluation. She underwent 2 vessel CABG in 2018. She was found to have ischemic cardiomyopathy, ejection fraction of 30% to 35% despite revascularization, and an implantable cardiac defibrillator (ICD). Three years following uncomplicated CABG, the patient presented with angina and sustained ventricular tachycardia; ICD therapy was unsuccessful. Ischemia was the etiology of the sustained ventricular tachycardia, and the patient underwent cardiac catheterization, demonstrating high-grade subclavian artery stenosis proximal to the LIMA bypass graft. Intervention of the 80% lesion of the native left anterior descending artery was done with placement of a 2.75×16-mm drug-eluting stent. The patient responded well to treatment, with no subsequent ventricular tachycardia on outpatient follow-up. Conclusions: This report has shown that in patients who present with symptoms of acute coronary syndrome and a history of CABG involving the LIMA, the possibility of CSSS should be considered and investigated by coronary artery imaging so that diagnosis and management are not delayed.

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Section: Discussionmentioning

confidence: 99%

Coronary Subclavian Steal Syndrome in a 73-Year-Old Woman Presenting with Angiographically Confirmed Subclavian Artery Stenosis Proximal to the Left Internal Mammary

2022

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An atypical case of early coronary subclavian steal syndrome after CABG managed with subclavian-subclavian crossover bypass and myocutaneous pectoralis major flap

Van Cauwenbergh,

Elshof,

Killaars

et al. 2024

Annals of Vascular Surgery - Brief Reports and Innovations

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Subclavian coronary steal syndrome in a post coronary artery bypass grafting patient: A case report

Parikh¹,

Shah²,

Shah³

et al. 2023

HVT

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Objective: "Subclavian coronary steal" refers to diversion of blood flow from coronary bed to subclavian artery. In patients receiving internal mammary grafts during coronary artery bypass grafting surgery (CABG), aorta and its proximal branches become part of coronary circulation. Atherosclerotic occlusion of subclavian artery can manifest as subclavian coronary steal syndrome and patients may present with angina, myocardial infarction and even sudden cardiac death. The objective of our case report is to identify and present important non-conventional causes of angina for better management of patients. Case presentation: A 50-year-old, hypertensive, male patient with a prior history of having undergone CABG, presented with CCS class III angina of one-month duration. He was found to have a completely occluded left subclavian artery from origin with retrograde flow of blood in left internal mammary artery from coronary to subclavian artery. Percutaneous transluminal angioplasty with stenting to subclavian artery was performed. Antegrade flow was established and coronary steal through left internal mammarian artery graft was thus abolished with subsequent resolution of symptoms. Conclusion:We have presented a case of refractory angina in post coronary artery bypass grafting patient who was eventually treated with percutaneous stent implantation to treat the subclavian stenosis; and had complete resolution of symptoms post intervention. Take home message: Patients undergoing CABG should be screened for a possible asymptomatic subclavian stenosis that may become symptomatic after CABG. Also, subclavian coronary steal syndrome should be suspected in patients presenting with refractory angina post CABG.

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Atypical and rare cause of myocardial infarction: coronary subclavian steal syndrome (CSSS) treated by a carotid-subclavian bypass in a 71-year-old female patient

Cited by 3 publications

References 16 publications

Coronary Subclavian Steal Syndrome in a 73-Year-Old Woman Presenting with Angiographically Confirmed Subclavian Artery Stenosis Proximal to the Left Internal Mammary

Coronary Subclavian Steal Syndrome in a 73-Year-Old Woman Presenting with Angiographically Confirmed Subclavian Artery Stenosis Proximal to the Left Internal Mammary

An atypical case of early coronary subclavian steal syndrome after CABG managed with subclavian-subclavian crossover bypass and myocutaneous pectoralis major flap

Subclavian coronary steal syndrome in a post coronary artery bypass grafting patient: A case report

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