Coronary–subclavian steal phenomenon late after coronary artery bypass grafting: an underappreciated cause of myocardial ischemia?

Unmasking the Coronary-Subclavian Steal Syndrome: The Culprit Lies in the Subclavian Artery. A Report of a Case and Review of the Literature

The coronary-subclavian steal syndrome is a hemodynamic phenomenon in which a subclavian artery stenosis or occlusion impairs blood flow at the origin of the left internal mammary artery used for coronary artery bypass grafting (CABG), causing retrograde blood flow and thus provoking symptoms of cardiac ischemia and its complications. Once considered the gold-standard operation of choice, open revascularization has now been abandoned as a first line treatment and replaced by endovascular techniques. In all cases, detailed and oriented physical examination in combination with further imaging in high clinical suspicion for coronary-subclavian steal syndrome remains the sine qua non of the preoperative examination of the patient. We report the case of a 50-year-old male patient suffering from acute onset angina post- coronary artery bypass grafting and managed by endovascular means.

Endovascular treatment of coronary subclavian steal syndrome complicated with STEMI and VF: A case report and review of the literature

Endovascular treatment of coronary subclavian steal syndrome is usually successful and safe. However, it might be lethally complicated, such as our case of STEMI and ventricular fibrillation during stent deployment. Early diagnosis of subclavian stenosis, intermittent dilations of balloons during stent deployment, and choosing the accurate stent size are suggested to avoid such complications.

Abnormal origin of internal thoracic artery from the thyrocervical trunk: surgical considerations

An unusual case of left internal thoracic artery (ITA) origin from the thyrocervical trunk (TCT) was detected during routine cadaver dissection. The variability of origin and course of ITA has less or more frequently been documented in the literature. However, the ITA origin from the TCT on the left side has been detected less commonly, making its dissection and preparation during coronary artery bypass grafting surgery more difficult. We discuss the ITA origin and course variability as well as clinical significance of the present variant, reviewing the relative literature. The objective of our study is to exhibit a rare ITA origin in order to provide a more accurate knowledge of such variations.