[Coronary-subclavian steal syndrome].
METHODS
A-46-year-old woman with generalized atherosclerosis and coronary triple vessel disease was admitted with recurrent angina pectoris 17 months after primarily successful triple coronary artery bypass grafting (CABG). The symptoms were induced by exercise of the arms, e. g. carrying shopping bags in the left hand.


METHODS
Stress technetium scans showed pronounced left ventricular ischemia of the anterior wall and apex during left upper limb exercise in comparison to bicycle exercise. The coronary angiography showed reverse flow in the internal mammary artery (IMA) graft to the left anterior descending artery (LAD), and aortography disclosed blockage of the proximal left subclavian artery.


METHODS
: The patient declined percutaneous transluminal interventions or surgical procedures of the left subclavian artery. Because of mild angina and the lack of neurological symptoms, she was discharged on optimal drug treatment.


CONCLUSIONS
: Patients with recurrence of cardiac symptoms after CABG surgery and IMA graft may have a coronary-subclavian steal syndrome. Clinically, these patients present with arterial blood pressure differences between left and right arm of typically more than 20 mmHg. The therapy of choice are percutaneous transluminal revascularization procedures of the subclavian artery.
Bäumer
A T
AT
Klinik III für Innere Medizin, Germany.
Nickenig
G
G
Moka
D
D
Böhm
M
M
D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000175:diagnosis*; D013349:Subclavian Steal Syndrome / Q000175:diagnosis*