title: Endovascular treatment of late coronary-subclavian steal syndrome.
abstract: OBJECTIVE
  Coronary-subclavian steal syndrome (CSSS) is a rare cause of myocardial ischemia subsequent to stenosis or occlusion of the subclavian artery (SA) proximal to internal thoracic artery (ITA) coronary bypass. Only single cases have been reported in published studies to date. We report a significant series of patients with late CSSS treated through an endovascular approach.
  
  
  METHODS
  We reviewed a series of consecutive patients treated for CSSS. The clinical, anatomic, and technical characteristics of the procedures were considered. Follow-up was performed through clinical and laboratory (electrocardiography, echocardiography, duplex ultrasonography) evaluations.
  
  
  RESULTS
  From January 2005 to March 2013, 10 patients with CSSS were treated; 7 had stable and 3 unstable angina. Of the 10 patients, 8 had left SA stenosis (6 ostial to the origin and 2 in the middle segment), 1 had proximal occlusion of the left SA, and 1 had stenosis in the innominate artery (proximally to a right internal thoracic artery). Arterial access was at the brachial artery through surgical exposure (n=6), or radial artery percutaneously (n=3). In 1 case of proximal occlusion of the left SA, simultaneous femoral and percutaneous radial access was necessary. Predilatation of the stenotic lesion was performed in 6. Balloon expandable stents were used in 7 patients with proximal ostial stenosis or occlusion and self-expandable stents in 2 with nonostial lesions. In 1 other patient with proximal heavy calcified stenosis, cutting-balloon predilatation was performed, resulting in dissection of the SA and occlusion of the ITA graft; blood flow was restored in the left upper arm and myocardium by adjunctive dilatation of the SA and endovascular coronary revascularization. No patients developed angina during the follow-up period (15±7 months).
  
  
  CONCLUSIONS
  A tailored endovascular approach can be used to treat CSSS. However, the occurrence of potentially lethal complications is possible and needs prompt correction.
authors: Department of Vascular Surgery, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors: Gianluca
authors: G
authors: Faggioli
authors: Department of Vascular Surgery, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. Electronic address: rudypini@gmail.com.
authors: Rodolfo
authors: R
authors: Pini
authors: Interventional Cardiovascular Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy.
authors: Alberto
authors: A
authors: Cremonesi
authors: Interventional Cardiovascular Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy.
authors: Chiara
authors: C
authors: Grattoni
authors: Department of Vascular Surgery, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors: Matteo
authors: M
authors: Longhi
authors: Department of Vascular Surgery, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors: Raffaella
authors: R
authors: Mauro
authors: Interventional Cardiovascular Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy.
authors: Fausto
authors: F
authors: Castriota
authors: Department of Vascular Surgery, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors: Andrea
authors: A
authors: Stella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D003251:Constriction, Pathologic; D058686:Coronary-Subclavian Steal Syndrome / Q000175:diagnosis / Q000628:therapy*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency