Subclavian coronary steal syndrome: an obligatory common fate between subclavian artery, internal mammary graft and coronary circulation.
The long-term patency of the left internal mammary artery (IMA) has made it the preferred conduit for myocardial revascularization. The proximal segment of the subclavian artery becomes functionally connected to the coronary circulation as a result of IMA implantation during coronary artery bypass surgery. The subclavian coronary steal syndrome results from stenosis in the left subclavian artery proximal to the IMA, compromising blood flow to the myocardium. We describe 7 patients, aged 55-75 years, 1.7-10.5 years after coronary bypass who presented with recurrent angina due to subclavian artery stenosis. The IMA graft was found open in each patient. A true steal mechanism was not demonstrated, casting doubt on the syndrome's traditional name. Angioplasty and stenting of the subclavian artery resulted in the immediate disappearance of angina and continuous benefit at a follow-up of 3-32 months. The subclavian coronary steal syndrome, although rare, is a severe condition readily treated by angioplasty and stenting.
Elian
Dan
D
Heart Institute, Sheba Medical Center, Tel Hashomer 52621, Israel. eliandan@internet-zahav.net
Gerniak
Alexander
A
Guetta
Victor
V
Jonas
Michael
M
Agranat
Oren
O
Har-Zahav
Yedael
Y
Rath
Shmuel
S
Di Segni
Elio
E
D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000503:physiopathology; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000637:transplantation; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000637:transplantation; D013349:Subclavian Steal Syndrome / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology