title: [An unexpected culprit lesion: subclavian artery stenosis].
abstract: After non-ST-elevation myocardial infarction, a 61-year-old woman underwent coronary artery bypass grafting with left internal mammary artery (LIMA) to left anterior descending artery combined with saphenous vein grafts to the second obtuse marginal branch and the right coronary artery. At age 79, she was admitted for anterior non-ST-elevation myocardial infarction. Echocardiography showed hypokinesia of the left anterior descending territory. From the left radial approach the LIMA graft was patent, but a critical stenosis of the proximal subclavian artery was diagnosed and treated with stenting. The coronary subclavian steal syndrome usually presents with effort angina but has rarely been reported as a cause of myocardial infarction. A coronary steal syndrome should be suspected in patients with internal mammary artery bypass with recurrence of angina but also in case of acute coronary syndrome. When stable angina is present, a computed tomography scan of the bypass and subclavian artery may allow diagnosis before coronary angiography. In case of urgent coronary angiography and undetectable culprit lesions, selective angiography of the subclavian artery may confirm the suspicion of the coronary steal syndrome.
authors.affiliation: U.O. Cardiologia, Ospedale della Misericordia, AUSL di Grosseto, Grosseto.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cresti
authors.affiliation: U.O. Cardiologia, Ospedale della Misericordia, AUSL di Grosseto, Grosseto.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Misuraca
authors.affiliation: U.O. Diagnostica per Immagini e Radiologia Interventistica, Ospedale della Misericordia, AUSL di Grosseto, Grosseto.
authors.forename: Massimo
authors.initials: M
authors.lastname: Pieraccini
authors.affiliation: U.O. Cardiologia, Ospedale della Misericordia, AUSL di Grosseto, Grosseto.
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabria
authors.affiliation: Scuola di Specializzazione in Cardiologia, Università degli Studi, Siena.
authors.forename: Liliana
authors.initials: L
authors.lastname: Sinesi
authors.affiliation: U.O. Cardiologia, Ospedale della Misericordia, AUSL di Grosseto, Grosseto.
authors.forename: Andrea
authors.initials: A
authors.lastname: Picchi
authors.affiliation: U.O. Cardiologia, Ospedale della Misericordia, AUSL di Grosseto, Grosseto.
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
authors.affiliation: U.O. Cardiologia, Ospedale della Misericordia, AUSL di Grosseto, Grosseto.
authors.forename: Silva
authors.initials: S
authors.lastname: Severi
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D009203:Myocardial Infarction / Q000209:etiology* / Q000473:pathology; D015607:Stents; D013349:Subclavian Steal Syndrome / Q000150:complications / Q000175:diagnosis*