Use of angioplasty in the prevention and treatment of coronary--subclavian steal syndrome.
OBJECTIVE
The coronary-subclavian artery steal (CSS) syndrome is caused by critical stenosis in the subclavian artery proximal to a bypass graft from the internal mammary artery (IMA) to the coronary artery. The stenosis results in retrograde flow in the IMA and steal from the coronary artery.


METHODS
Percutaneous transluminal angioplasty (PTA) was performed in eight patients (five men, three women). In four patients (group 1), coronary ischemia had developed 0.5-70 months (mean, 31 months) after IMA-to-coronary artery bypass surgery. These four patients (mean age, 58 years; range, 44-68 years) underwent PTA of a single area of focal subclavian stenosis to treat CSS. In four other patients (group 2), atherosclerotic subclavian stenosis had developed proximal to a donor IMA before planned bypass surgery. These patients (mean age, 53 years; range, 50-57 years) underwent PTA of a single focal subclavian stenosis to prevent CSS.


RESULTS
Group 1 patients were free of myocardial ischemia at follow-up (mean follow-up, 39.0 months; range, 14-101 months). Three of four patients in group 2 underwent coronary artery bypass grafting with the ipsilateral IMA following PTA of the subclavian stenosis; they were free of angina at follow-up (mean follow-up, 14 months; range, 10-18 months).


CONCLUSIONS
PTA is a safe and efficacious short-term method for prevention and treatment of CSS syndrome.
Hallisey
M J
MJ
Division of Vascular and Interventional Radiology, University of Connecticut School of Medicine, Hartford Hospital, USA.
Rees
J H
JH
Meranze
S G
SG
Siegfeld
A
A
Lowe
R
R
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000517:prevention & control / Q000628:therapy; D000800:Angioplasty, Balloon; D001161:Arteriosclerosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D013348:Subclavian Artery; D013349:Subclavian Steal Syndrome / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*