title: How should I treat a complex left subclavian artery stenosis involving the vertebral artery in a patient with subclavian steal syndrome and left internal mammary artery bypass graft?
abstract: BACKGROUND
  A 68-year-old male smoker presented with progressive symptoms of vertebrobasilar insufficiency and angina. His past medical history included arterial hypertension, diabetes mellitus, dyslipidaemia as well as diffuse coronary artery disease including left main disease. Of note, he had undergone coronary bypass surgery 12 years earlier utilising the left internal mammary artery.
  
  
  METHODS
  Physical examination, laboratory tests, duplex ultrasound imaging, contrast-enhanced magnetic resonance imaging and coronary angiography.
  
  
  METHODS
  Severe bifurcation stenosis of the left subclavian and vertebral artery with consecutive subclavian steal syndrome and myocardial ischaemia.
  
  
  RESULTS
  Bifurcation T-stenting using a self-expandable bare metal and a coronary drug-eluting stent.
authors: Department of Angiology, 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors: Tareq
authors: T
authors: Ibrahim
authors: Nicolas
authors: N
authors: Langwieser
authors: Michael
authors: M
authors: Dommasch
authors: Moritz
authors: M
authors: Wildgruber
authors: Karl-Ludwig
authors: KL
authors: Laugwitz
authors: Hans
authors: H
authors: Krankenberg
authors: Marco
authors: M
authors: Roffi
authors: Alberto
authors: A
authors: Cremonesi
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D023903:Coronary Restenosis / Q000150:complications; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D013349:Subclavian Steal Syndrome / Q000150:complications / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000601:surgery*