Subclavian artery occlusion causing acute myocardial infarction in a patient with a left internal mammary artery graft.
Although atherosclerotic disease of the subclavian artery has previously been reported to cause coronary-subclavian steal syndrome, acute myocardial infarction because of occlusion of the subclavian artery in a graft-dependent coronary circulation is an uncommon and previously unreported mode of clinical presentation. Increasingly, patients undergoing high-risk cardiopulmonary procedures have comorbidities with extensive atherosclerotic disease of many vascular beds including coronary, cranial, and peripheral. Our discussion reviews the clinical presentation of such a case and highlights some of the important treatment options available when confronted with such a finding. The successful outcome achieved by percutaneous stenting of the subclavian artery and salvage of the graft may indicate that this modality is the initial treatment of choice in such cases.
Barlis
Peter
P
Department of Cardiology, Austin Hospital, PO Box 5555, Heidelberg, Victoria 3084, Australia. P.Barlis@rbht.nhs.uk
Brooks
Mark
M
Hare
David L
DL
Chan
Robert K
RK
D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000150:complications*; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000601:surgery*; D004562:Electrocardiography; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D007690:Polycystic Kidney Diseases / Q000453:epidemiology; D013348:Subclavian Artery