1
|
Cua B, Mamdani N, Halpin D, Jhamnani S, Jayasuriya S, Mena-Hurtado C. Review of coronary subclavian steal syndrome. J Cardiol 2017; 70:432-437. [PMID: 28416323 DOI: 10.1016/j.jjcc.2017.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/01/2017] [Accepted: 02/17/2017] [Indexed: 11/25/2022]
Abstract
The clinical benefits of using the left internal mammary artery (LIMA) to bypass the left anterior descending artery are well established making it the most frequently used conduit for coronary artery bypass surgery (CABG). Coronary subclavian steal syndrome (CSSS) occurs during left arm exertion when (1) the LIMA is used during bypass surgery and (2) there is a high grade (≥75%) left subclavian artery stenosis or occlusion proximal to the ostia of the LIMA resulting in "stealing" of the myocardial blood supply via retrograde flow up the LIMA graft to maintain left upper extremity perfusion. Although CSSS was once thought to be a rare phenomenon, its prevalence has been underestimated and is becoming increasingly recognized as a serious threat to the success of CABG. Current guidelines are lacking on recommendations for screening of subclavian artery stenosis (SAS) pre- and post-CABG. We hope to provide an algorithm for SAS screening to prevent CSSS in internal mammary artery bypass recipients and review treatment options in the percutaneous era.
Collapse
Affiliation(s)
- Bennett Cua
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Natasha Mamdani
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Halpin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Sunny Jhamnani
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Sasanka Jayasuriya
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
2
|
Kink of Subclavian Artery Mimicking Stenosis. Case Rep Cardiol 2017; 2016:4274936. [PMID: 28058118 PMCID: PMC5183746 DOI: 10.1155/2016/4274936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/13/2016] [Indexed: 11/18/2022] Open
Abstract
The treatment for subclavian artery stenosis includes the more common endovascular therapy rather than surgical intervention in symptomatic patients. We present a case of a 79-year-old man with coronary artery bypass graft where subclavian artery stenosis was found incidentally. In this asymptomatic case, we have merged clinical and multiple imaging modalities to secure the diagnosis and treatment plan.
Collapse
|
3
|
Coronary-subclavian steal syndrome following CABG: A case report and literature review. Res Cardiovasc Med 2017. [DOI: 10.5812/cardiovascmed.34079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
4
|
de Almeida BL, Kambara AM, Rossi FH, Moreira SM, de Oliveira ESJ, Linhares Filho FADC, Metzger PB, Passalacqua AZ. Left subclavian artery stenting: an option for the treatment of the coronary-subclavian steal syndrome. Braz J Cardiovasc Surg 2015; 29:236-40. [PMID: 25140474 PMCID: PMC4389454 DOI: 10.5935/1678-9741.20140031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 08/19/2013] [Indexed: 11/20/2022] Open
Abstract
Introduction The subclavian steal syndrome is characterized by the vertebral artery flow
inversion, due to a stenotic lesion in the origin of the subclavian artery. The
Coronary-subclavian Steal Syndrome is a variation of the Subclavian Steal Syndrome
and is characterized by inversion of flow in the Internal Thracic artery that has
been used as conduct in a myocardial revascularization. Its diagnosis must be
suspected in patients with difference in pulse and arterial pressure in the upper
limbs, that present with angina pectoris and that have done a myocardial
revascularization. Its treatment must be a surgical bypass or a transluminal
angioplasty. Objective The objective is to show the left subclavian artery stenting as a safe and
effective method to treat the coronary-subclavian steal syndrome. Methods Historical prospective, non-randomized trial, through revision of the hospital
records of the patients treated with the stenting of the left subclavian artery,
from January 2006 to September 2012. Results In the mentioned period, 4.291 miocardial revascularizations were performed with
the use of the left mammary artery, and 16 patients were identified to have the
Coronary-subclavian steal syndrome. All of them were submitted to endovascular
treatment. The success rate was 100%; two patients experienced minor
complications; none of them presented with major complications. Eleven of the 16
patients had ultrassonographic documentation of patent stent for at least one
year; two patients lost follow up and other two died. Conclusion The stenting of the left subclavian artery is a good option for the treatment of
the Coronary-subclavian Steal Syndrome, with high level of technical and clinical
success.
Collapse
Affiliation(s)
- Bruno Lorenção de Almeida
- Correspondence address: Bruno Lorenção de Almeida, Instituto Dante
Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500 - Vila Mariana - São Paulo,
SP, Brazil - Zip code: 04012-180. E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW Coronary subclavian steal syndrome (CSSS) is the reversal of blood flow in an internal mammary artery bypass graft that results in coronary ischemia. CSSS is an uncommon but treatable cause of coronary ischemia. In this review, we highlight the historical background and epidemiology of CSSS, common clinical presentations, diagnosis of CSSS and management strategies for relieving ischemia. We also present a case report to illustrate the complexity of CSSS and percutaneous management using current technology. RECENT FINDINGS Most commonly, CSSS results from atherosclerotic stenosis of the subclavian artery and occurs in 2.5-4.5% of patients referred for coronary artery bypass grafting (CABG). All patients referred for CABG should have bilateral noninvasive brachial blood pressures checked to screen for the underlying subclavian stenosis. A review of 98 case reports with 128 patients demonstrated a diverse clinical presentation of CSSS, including acute myocardial infarction, unstable angina and acute systolic heart failure. Resolution of CSSS symptoms has been reported with both surgical and percutaneous revascularization. Long-term patency with either revascularization strategy is excellent. Percutaneous revascularization is largely considered the first-line therapy for CSSS and can be safely performed prior to CABG to prevent CSSS. SUMMARY CSSS should be suspected in patients presenting with angina, heart failure or myocardial infarction after CABG. Successful amelioration of CSSS symptoms can be safely and effectively performed via percutaneous revascularization.
Collapse
|
6
|
High-risk acute coronary syndrome in a patient with coronary subclavian steal syndrome secondary to critical subclavian artery stenosis. Case Rep Cardiol 2014; 2014:175235. [PMID: 25161771 PMCID: PMC4137696 DOI: 10.1155/2014/175235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022] Open
Abstract
Patients with multivessel coronary artery disease are more likely to have extensive atherosclerosis that involves other major arteries. Critical subclavian artery (SCA) stenosis can result in coronary subclavian steal syndrome that may present as recurrent ischemia and even myocardial infarction in patients with coronary artery bypass graft (CABG). In patients with concomitant severe native coronary disease, occluded saphenous venous grafts (SVG) to other arteries, percutaneous intervention on critical subclavian artery (SCA) stenosis that will compromise the blood flow to left internal mammary graft (LIMA) and left anterior descending (LAD) artery will be a high-risk procedure and may be associated with cardiogenic shock, especially in patients with preexisting ischemic cardiomyopathy. The use of percutaneous left ventricular (LV) assist device like Impella will offer better hemodynamic support and coronary perfusion and therefore results in decreased myocardial damage, maximized residual cardiac function, and lower incidence of cardiogenic shock.
Collapse
|
7
|
Shinozaki N, Suzuki T, Ikari Y. Effective emergent endovascular recanalization for acute coronary syndrome with left subclavian artery occlusion in a prior coronary artery bypass graft patient. Cardiovasc Interv Ther 2014; 29:368-71. [PMID: 24399502 DOI: 10.1007/s12928-013-0242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/27/2013] [Indexed: 11/28/2022]
Abstract
A 78-year-old female was hospitalized because of multiple bone fracture caused by falling down. She undertook coronary artery bypass graft (CABG) using left internal mammary artery (LIMA) about 10 years ago. She complained chest pain on the day of admission with hypotension. Emergent angiogram revealed total occlusion of left subclavian artery (SCA). We re-canalized left SCA with stent. Hemodynamics and symptom dramatically improved after the procedure. Acute coronary syndrome due to SCA occlusion after CABG using LIMA was rare, but we have to consider the possibility. Endovascular therapy to SCA lesion might be a proper strategy for these cases.
Collapse
Affiliation(s)
- Norihiko Shinozaki
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan,
| | | | | |
Collapse
|
8
|
Tiryakioglu SK, Tiryakioglu O, Kaya U. The place of carotico-subclavian bypass surgery in angina treatment. Heart Views 2013; 14:82-4. [PMID: 23983913 PMCID: PMC3752881 DOI: 10.4103/1995-705x.115502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Coronary-subclavian steal syndrome results from atherosclerotic disease of the proximal subclavian artery, causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass. In the present case, we discussed the diagnosis and the treatment of coronary steal syndrome in a patient hospitalized due to decompensated cardiac insufficiency.
Collapse
|
9
|
Babic SD, Radak DJ, Sotirovic VA, Unic-Stojanovic DR, Babic DS, Popov PZ, Sagic DZ. Technical Strategy in a Patient with Symptomatic Thoracic Aneurysm Near the Origin of the Left Subclavian Artery and Left Internal Thoracic Artery Coronary Graft. J Card Surg 2012; 27:725-7. [DOI: 10.1111/jocs.12018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Coronary subclavian steal syndrome causing acute myocardial infarction in a patient undergoing coronary-artery bypass grafting. Case Rep Med 2012; 2012:798356. [PMID: 22969810 PMCID: PMC3437312 DOI: 10.1155/2012/798356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 07/31/2012] [Indexed: 11/18/2022] Open
Abstract
Coronary subclavian steal syndrome with retrograde blood flow in the left internal mammary-coronary bypass graft is a rare but severe complication of cardiac surgery. The authors present a case of a 68-year-old man after coronary-artery bypass grafting using an internal mammary artery. He had been suffering from angina pectoris for the last several years before surgery. The patient was resuscitated at home by emergency medical service because of primary ventricular fibrillation due to an acute myocardial infarction 5 years after surgery. An occlusion of the left subclavian artery with the retrograde blood flow in the left internal mammary coronary bypass was found. This could have been the cause of insufficiency in coronary blood flow and ischemia of the myocardial muscle. The subclavian artery occlusion was successfully treated with percutaneous transluminal angioplasty and implantation of 2 stents. The patient remained free of any symptoms 2 years after this procedure.
Collapse
|
11
|
Tanindi A, Cengel A, Akyel A, Akinci S. Relief of angina pectoris when carrying heavy loads with the left hand in a patient with previous coronary artery bypass graft operation who has severe exercise angina: a case report. Clin Cardiol 2010; 33:E73-5. [PMID: 20845407 DOI: 10.1002/clc.20436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Accepted: 02/24/2008] [Indexed: 11/10/2022] Open
Abstract
In patients with known coronary artery disease and/or a history of revascularization, angina pectoris or unstable coronary syndromes are usually attributed to the progression of atherosclerotic lesions rather than an unrecognized great vessel disease. However, for patients with a previous coronary artery bypass graft operation (CABG), during which a left internal mammary artery (LIMA) conduit has been used, great vessel disease, especially subclavian artery stenosis should also be suspected. We present a case of a patient with a LIMA conduit who has angina pectoris on exertion, but interestingly the pain is relieved when he carries heavy loads with his left hand, which can be due to increased blood flow to the LIMA conduit during heavy lifting because of increased peripheral resistance.
Collapse
Affiliation(s)
- Asli Tanindi
- Gazi University, Department of Cardiology, Besevler Ankara, Turkey.
| | | | | | | |
Collapse
|
12
|
Wu CH, Sung SH, Chang JCY, Huang CH, Lu TM. Subclavian artery thrombosis associated with acute ST-segment elevation myocardial infarction. Ann Thorac Surg 2010; 88:2036-8. [PMID: 19932294 DOI: 10.1016/j.athoracsur.2009.05.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 04/21/2009] [Accepted: 05/14/2009] [Indexed: 11/28/2022]
Abstract
Presentation of acute ST segment elevation myocardial infarction in the setting of acute subclavian artery thrombosis in a patient who underwent coronary artery bypass grafting with a left internal mammary artery graft, which is not believed to have been previously described. We report a 75-year-old woman with presentations of dizziness, nausea, left-arm numbness, and a cold left hand, who later had chest pain develop. Acute ST segment elevation myocardial infarction was diagnosed, and both a computed tomography and an angiography disclosed a thrombus extending from the proximal portion of the left subclavian artery to the orifice of the left internal mammary artery. The patient was free from the previously listed symptoms after undergoing emergent thrombectomy, with complete extraction of the long thrombus from the subclavian artery. Unfortunately, she died of pneumonia and septic shock 1 1/2 months later.
Collapse
Affiliation(s)
- Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.
| | | | | | | | | |
Collapse
|
13
|
Dimas B, Lindsey JB, Banerjee S, Brilakis ES. ST-Segment elevation acute myocardial infarction due to severe hypotension and proximal left subclavian artery stenosis in a prior coronary artery bypass graft patient. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2009; 10:191-4. [PMID: 19595403 DOI: 10.1016/j.carrev.2008.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Accepted: 08/13/2008] [Indexed: 11/28/2022]
Abstract
Proximal subclavian artery stenosis may result in cardiac ischemia in coronary artery bypass graft patients with internal mammary grafts. We report a case of acute anterior myocardial infarction in such a patient who developed severe systemic hypotension. Symptoms and electrocardiographic changes resolved after proximal left subclavian artery stenting. Subclavian angiography should be considered in all prior coronary artery bypass graft patients with internal mammary grafts undergoing coronary angiography.
Collapse
Affiliation(s)
- Billy Dimas
- VA North Texas Healthcare System, Dallas, TX 75216, USA
| | | | | | | |
Collapse
|
14
|
Al-Jundi W, Saleh A, Lawrence K, Choksy S. A case report of coronary-subclavian steal syndrome treated with carotid to axillary artery bypass. Case Rep Med 2009; 2009:687982. [PMID: 19721705 PMCID: PMC2728612 DOI: 10.1155/2009/687982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 06/20/2009] [Indexed: 11/17/2022] Open
Abstract
Coronary-subclavian steal syndrome results from atherosclerotic disease of the proximal subclavian artery causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass. This rare complication of cardiac revascularisation leads to recurrence of myocardial ischaemia. When feasible, subclavian angioplasty and/or stent placement can provide acceptable result for these patients. Vascular reconstruction through carotid to subclavian artery bypass has been the standard procedure of choice. Other interventions in literature include axilloaxillary bypass and subclavian carotid transposition. This case report describes the use of carotid axillary artery bypass for the treatment of coronary-subclavian steal syndrome.
Collapse
Affiliation(s)
- Wissam Al-Jundi
- Colchester Hospital University NHS Foundation Trust, Colchester, Essex CO4 5JL, UK
| | - Aiman Saleh
- Colchester Hospital University NHS Foundation Trust, Colchester, Essex CO4 5JL, UK
| | - Kathryn Lawrence
- Colchester Hospital University NHS Foundation Trust, Colchester, Essex CO4 5JL, UK
| | - Sohail Choksy
- Colchester Hospital University NHS Foundation Trust, Colchester, Essex CO4 5JL, UK
| |
Collapse
|