Anterograde flow compromise of a patent left internal mammary artery graft from a proximal subclavian artery stenosis. Myocardial ischemia not driven by the coronary-subclavian steal syndrome mechanism.
A 54-year male with previous triple vessel coronary artery and aorto-bi-femoral bypass graft surgeries complained of crescent angina. Stress induced myocardial ischemia on echocardiography was demonstrated. We performed direct stenting of a saphenous vein graft to the right coronary artery, via right radial approach. Subsequently stenting of a severe left subclavian artery proximal stenosis was performed via right brachial approach in order to relieve an overt myocardial ischemia in the territory supplied by a patent left internal mammary artery graft originated distally to the left subclavian stenosis. The finding of a total left axillary artery occlusion complement the pathogenesis of myocardial ischemia produced by limited anterograde flow and not driven by the common flow reversal mechanism of a typical coronary-subclavian steal syndrome.
Cardiovascular and Hemodynamic Unit. Hospital Regional 1° de Octubre, ISSSTE. Mexico City, Mexico.
Alejandro
A
Alcocer
Genaro
G
Castillo
Juan M
JM
Rivera-Capello
Vidal
V
González
Eduardo
E
Meaney
D001157:Arterial Occlusive Diseases / Q000150:complications*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D058686:Coronary-Subclavian Steal Syndrome; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*; D013348:Subclavian Artery