Unmasking the Coronary-Subclavian Steal Syndrome: The Culprit Lies in the Subclavian Artery. A Report of a Case and Review of the Literature

Ann Vasc Surg. 2021 Jul:74:524.e9-524.e15. doi: 10.1016/j.avsg.2021.02.009. Epub 2021 Apr 6.

Abstract

The coronary-subclavian steal syndrome is a hemodynamic phenomenon in which a subclavian artery stenosis or occlusion impairs blood flow at the origin of the left internal mammary artery used for coronary artery bypass grafting (CABG), causing retrograde blood flow and thus provoking symptoms of cardiac ischemia and its complications. Once considered the gold-standard operation of choice, open revascularization has now been abandoned as a first line treatment and replaced by endovascular techniques. In all cases, detailed and oriented physical examination in combination with further imaging in high clinical suspicion for coronary-subclavian steal syndrome remains the sine qua non of the preoperative examination of the patient. We report the case of a 50-year-old male patient suffering from acute onset angina post- coronary artery bypass grafting and managed by endovascular means.

Keywords: CABG; Subclavian artery; coronary-subclavian steal syndrome; internal mammary artery.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Angina, Unstable / diagnosis*
  • Angina, Unstable / etiology
  • Angina, Unstable / physiopathology
  • Angina, Unstable / therapy
  • Angioplasty, Balloon / instrumentation
  • Coronary Circulation*
  • Coronary-Subclavian Steal Syndrome / diagnosis*
  • Coronary-Subclavian Steal Syndrome / etiology
  • Coronary-Subclavian Steal Syndrome / physiopathology
  • Coronary-Subclavian Steal Syndrome / therapy
  • Hemodynamics*
  • Humans
  • Internal Mammary-Coronary Artery Anastomosis / adverse effects*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Regional Blood Flow
  • Risk Factors
  • Stents
  • Subclavian Artery / diagnostic imaging
  • Subclavian Artery / physiopathology*
  • Subclavian Steal Syndrome / diagnosis*
  • Subclavian Steal Syndrome / etiology
  • Subclavian Steal Syndrome / physiopathology
  • Subclavian Steal Syndrome / therapy
  • Treatment Outcome