Myocardial thievery: the coronary-subclavian steal syndrome.
Coronary-subclavian steal syndrome entails the reversal of blood flow in a previously constructed internal mammary artery coronary conduit, which produces myocardial ischemia. The most frequent cause of the syndrome is atherosclerotic disease in the ipsilateral, proximal subclavian artery. Although coronary-subclavian steal was initially reported to be rare, the increasing documentation of this phenomenon and its potentially catastrophic consequences in recent series suggests that the incidence of the problem has been underreported and that its clinical impact has been underestimated. We review the causes and background of coronary-subclavian steal; methods of preventing, diagnosing, and treating it; and the potential influence of various treatment regimens on long-term survival and the likelihood of late adverse events in patients with coronary-subclavian steal syndrome.
Takach
Thomas J
TJ
Department of Cardiovascular Surgery, The Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas, USA.
Reul
George J
GJ
Cooley
Denton A
DA
Duncan
J Michael
JM
Livesay
James J
JJ
Ott
David A
DA
Gregoric
Igor D
ID
D000925:Anticoagulants / Q000627:therapeutic use; D001132:Arm / Q000098:blood supply; D001167:Arteritis / Q000150:complications; D050197:Atherosclerosis / Q000150:complications*; D016122:Brachiocephalic Trunk / Q000503:physiopathology; D002932:Cineangiography; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007387:Internal Mammary-Coronary Artery Anastomosis; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control; D008323:Mammary Arteries / Q000601:surgery; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D013348:Subclavian Artery / Q000503:physiopathology*; D013577:Syndrome; D014656:Vascular Surgical Procedures
D000925:Anticoagulants