Subclavian stent implantation to alleviate coronary steal through a patent internal mammary artery graft.
OBJECTIVE
Interventional techniques are rapidly supplanting conventional surgical therapies for the treatment of brachiocephalic occlusive disease. Although coronary-subclavian steal has been successfully alleviated with subclavian angioplasty, we report the first use of a Palmaz stent in the left subclavian artery (SCA) of a patient with a compromised left internal mammary artery (IMA) graft.


RESULTS
A 65-year old male patient had undergone triple coronary artery bypass grafting in 1992, but 6 months later, severe narrowing occurred in two of the saphenous vein grafts, and arteriography identified a high-grade stenosis in the SCA supplying the left IMA graft to the left anterior descending coronary artery. Following balloon dilation of one saphenous vein graft stenosis, the left SCA was stented primarily with a P3008 Palmaz stent. Normal hemodynamics were restored, and the patient has been free of coronary steal symptoms for over 1 year.


CONCLUSIONS
This case illustrates yet another aspect to the usefulness of intravascular stents in restoring and maintaining inflow to bypass grafts.
Diethrich
E B
EB
Department of Cardiovascular Surgery, Arizona Heart Institute & Foundation, Phoenix 85006, USA.
Cozacov
J C
JC
D000368:Aged; D002404:Catheterization; D003251:Constriction, Pathologic; D003324:Coronary Artery Disease / Q000628:therapy*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D012008:Recurrence; D012501:Saphenous Vein / Q000473:pathology / Q000637:transplantation; D015607:Stents; D013348:Subclavian Artery