title: Coronary-subclavian steal syndrome. A case report.
abstract: Coronary-subclavian steal is an unusual clinical syndrome after successful internal mammary-coronary artery bypass grafting. Proximal subclavian artery (SA) stenosis is present and atherosclerotic disease is the underlying pathophysiologic mechanism in the majority of cases. The authors report a case of a sixty-two-year old man with angina and ventricular fibrillation soon after myocardial revascularization with left internal mammary artery (LIMA) to left anterior descending coronary (LAD). Dobutamine stress echocardiography showed ischemia in the anterior myocardial territory with patent LIMA-LAD bypass in the angiographic evaluation. This procedure showed occlusion of the proximal SA with reversal of flow in the LIMA. The best therapeutic approach was discussed and a carotid-subclavian bypass was performed with restoration of antegrade blood flow and reversal of the clinical setting.
authors.affiliation: Serviço de Cardiologia do Hospital Garcia de Orta, Almada, Portugal. dr_jumberto@netc.pt
authors.forename: Jorge
authors.initials: J
authors.lastname: Guardado
authors.forename: João
authors.initials: J
authors.lastname: Goulão
authors.forename: Helder
authors.initials: H
authors.lastname: Pereira
authors.forename: Rui
authors.initials: R
authors.lastname: Caria
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Vieira
authors.forename: Gil
authors.initials: G
authors.lastname: Marques
authors.forename: Daniel
authors.initials: D
authors.lastname: Menezes
authors.forename: Manuel
authors.initials: M
authors.lastname: Carrageta
mesh_terms: D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013349:Subclavian Steal Syndrome / Q000175:diagnosis / Q000209:etiology*