RESUMEN
Coronary subclavian steal syndrome (CSSS) caused by left subclavian artery (LSA) stenosis is a rare cause of myocardial infarction in patients having coronary artery bypass grafting (CABG), and it has also been observed after an arteriovenous fistula (AVF) was made. A 79-year-old woman who had undergone CABG years earlier and an AVF creation 1 month before experienced a non-ST-elevation myocardial infarction (NSTEMI). While selective catheterization of the left internal thoracic artery graft was impossible, a computed tomography scanner showed patency of all bypasses and proximal subocclusive LSA stenosis, and the digital blood pressure measurements objectified a haemodialysis-induced distal ischaemia. LSA's angioplasty and covered stent placement were successfully performed, resulting in symptom remission. A CSSS-induced NSTEMI due to a LSA stenosis aggravated by a homolateral AVF several years after CABG has been documented only infrequently. If vascular access is required in the presence of CSSS risk factors, the contralateral upper limb should be preferred.
Asunto(s)
Síndrome de Robo Coronario-Subclavio , Infarto del Miocardio , Infarto del Miocardio sin Elevación del ST , Síndrome del Robo de la Subclavia , Femenino , Humanos , Anciano , Síndrome de Robo Coronario-Subclavio/diagnóstico , Síndrome de Robo Coronario-Subclavio/etiología , Síndrome de Robo Coronario-Subclavio/cirugía , Constricción Patológica/complicaciones , Síndrome del Robo de la Subclavia/diagnóstico , Síndrome del Robo de la Subclavia/etiología , Síndrome del Robo de la Subclavia/cirugía , Infarto del Miocardio/complicacionesRESUMEN
Coronary subclavian steal syndrome is an uncommon cause of angina in patients with a previous coronary artery bypass graft procedure. The patient had chest pain with the exertion of the left upper limb, difference in blood pressure between the left and right arm, occlusion at the ostium of the left subclavian artery. He underwent carotid subclavian bypass surgery that was successful in relieving symptoms. On the other hand, the patient had an embolic stroke related to the procedure and further assessment may be necessary.
Asunto(s)
Síndrome de Robo Coronario-Subclavio , Síndrome del Robo de la Subclavia , Masculino , Humanos , Síndrome de Robo Coronario-Subclavio/diagnóstico por imagen , Síndrome de Robo Coronario-Subclavio/cirugía , Síndrome de Robo Coronario-Subclavio/complicaciones , Síndrome del Robo de la Subclavia/diagnóstico por imagen , Síndrome del Robo de la Subclavia/cirugía , Puente de Arteria Coronaria/efectos adversos , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugía , Angina de Pecho/etiologíaRESUMEN
BACKGROUND: The coronary subclavian steal syndrome (CSSS) is a rare complication after coronary arterial bypass graft operations (CABG) using the left or right internal mammary artery ((L/R)IMA). It results from a retrograde blood flow from the IMA into the subclavian artery (SA) due to a stenosis or occlusion of the SA proximal to the IMA origin. This "steal phenomenon" leads to a decreased blood flow in the IMA and may result in myocardial ischemia (MIS) and even myocardial infarction (MIN). Treatment options include interventional and surgical therapy. CASE PRESENTATION: We report the case of a 71-year old woman, who suffered from an acute non-ST elevation myocardial infarction (NSTEMI) 11 years after LIMA-CABG surgery and who was treated successfully with a carotid-subclavian bypass (CSB) after failed interventional therapy. CONCLUSION: CSB may be regarded as a viable treatment option for patients suffering CSSS in the case of MIS and even an acute MIN/NSTEMI, especially in the case of missing or failed interventional therapy attempts. Specialists in cardiothoracic and vascular surgery should be aware of possible CSSS conditions and know about appropriate diagnostic and therapeutic options.
Asunto(s)
Enfermedad de la Arteria Coronaria , Síndrome de Robo Coronario-Subclavio , Arterias Mamarias , Infarto del Miocardio , Anciano , Síndrome de Robo Coronario-Subclavio/diagnóstico por imagen , Síndrome de Robo Coronario-Subclavio/cirugía , Femenino , Humanos , Arterias Mamarias/diagnóstico por imagen , Arterias Mamarias/cirugía , Arteria SubclaviaAsunto(s)
Síndrome de Robo Coronario-Subclavio , Isquemia Miocárdica , Puente de Arteria Coronaria , Síndrome de Robo Coronario-Subclavio/diagnóstico , Síndrome de Robo Coronario-Subclavio/etiología , Síndrome de Robo Coronario-Subclavio/cirugía , Humanos , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/terapia , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugíaRESUMEN
Abstract The lateral costal artery has sometimes been identified as the culprit for the "steal phenomenon" after coronary artery bypass grafting, besides being occasionally used for myocardial revascularization. Its branches make anastomoses with the internal thoracic artery through lateral intercostal arteries. We aim to report, on three cases, the clinical significance of a well-developed lateral costal artery after coronary artery bypass grafting. Two out of three patients who underwent coronary artery bypass graft surgery in our center between June 2010 and August 2017, applied to us with stable angina pectoris, while the third one was diagnosed with acute coronary syndrome after applying to the emergency department. In coronary cineangiography, in all three cases, a well-developed accessory vessel arising from the proximal 2.5 cm segment of the left internal thoracic artery coursed as far as the 6th rib was detected, and it was confirmed to be the lateral costal artery. A stable angina pectoris in two of the patients was thought to be the result of steal phenomenon caused by the well-developed lateral costal artery. In the two cases with stable angina pectoris the lateral costal artery was obliterated via coil embolization. In the other case with the proximal left anterior descending artery stenosis, before percutaneous coronary intervention, the lateral costal artery was obliterated via coil embolization and the occluded subclavian artery was stented. Routine visualization in cineangiography and satisfactory surgical exploration of the left internal thoracic artery could be very helpful to identify any possible accessory branch of the left internal thoracic artery like the lateral costal artery.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Anciano , Arterias Torácicas/anomalías , Síndrome de Robo Coronario-Subclavio/complicaciones , Anastomosis Interna Mamario-Coronaria , Angina de Pecho/etiología , Costillas/irrigación sanguínea , Arterias Torácicas/cirugía , Cineangiografía , Síndrome de Robo Coronario-Subclavio/cirugía , Síndrome de Robo Coronario-Subclavio/diagnóstico por imagen , Angina de Pecho/cirugía , Angina de Pecho/diagnóstico por imagen , Revascularización MiocárdicaAsunto(s)
Enfermedad de la Arteria Coronaria/cirugía , Síndrome de Robo Coronario-Subclavio/diagnóstico por imagen , Síndrome de Robo Coronario-Subclavio/etiología , Anciano , Angiografía Coronaria , Síndrome de Robo Coronario-Subclavio/cirugía , Progresión de la Enfermedad , Disnea/etiología , Humanos , Masculino , Taquicardia Ventricular/etiologíaRESUMEN
The lateral costal artery has sometimes been identified as the culprit for the "steal phenomenon" after coronary artery bypass grafting, besides being occasionally used for myocardial revascularization. Its branches make anastomoses with the internal thoracic artery through lateral intercostal arteries. We aim to report, on three cases, the clinical significance of a well-developed lateral costal artery after coronary artery bypass grafting. Two out of three patients who underwent coronary artery bypass graft surgery in our center between June 2010 and August 2017, applied to us with stable angina pectoris, while the third one was diagnosed with acute coronary syndrome after applying to the emergency department. In coronary cineangiography, in all three cases, a well-developed accessory vessel arising from the proximal 2.5 cm segment of the left internal thoracic artery coursed as far as the 6th rib was detected, and it was confirmed to be the lateral costal artery. A stable angina pectoris in two of the patients was thought to be the result of steal phenomenon caused by the well-developed lateral costal artery. In the two cases with stable angina pectoris the lateral costal artery was obliterated via coil embolization. In the other case with the proximal left anterior descending artery stenosis, before percutaneous coronary intervention, the lateral costal artery was obliterated via coil embolization and the occluded subclavian artery was stented. Routine visualization in cineangiography and satisfactory surgical exploration of the left internal thoracic artery could be very helpful to identify any possible accessory branch of the left internal thoracic artery like the lateral costal artery.
Asunto(s)
Angina de Pecho/etiología , Síndrome de Robo Coronario-Subclavio/complicaciones , Anastomosis Interna Mamario-Coronaria , Arterias Torácicas/anomalías , Anciano , Angina de Pecho/diagnóstico por imagen , Angina de Pecho/cirugía , Cineangiografía , Síndrome de Robo Coronario-Subclavio/diagnóstico por imagen , Síndrome de Robo Coronario-Subclavio/cirugía , Femenino , Humanos , Persona de Mediana Edad , Revascularización Miocárdica , Costillas/irrigación sanguínea , Arterias Torácicas/cirugíaRESUMEN
Coronary subclavian steal syndrome is an uncommon cause of ischemia recurrence after coronary artery bypass grafting. Endovascular treatment of subclavian artery stenosis or occlusion is increasingly common and appears to offer a safe and effective alternative to surgical revascularization. We report a case of recurrent angina after coronary artery bypass grafting for critical subclavian artery stenosis. The anomalous origin of the vertebral artery from the aortic arch was an indication for endovascular treatment. We discuss the diagnostic difficulties and the management pitfalls of subclavian artery angioplasty in this syndrome.
Asunto(s)
Puente de Arteria Coronaria , Síndrome de Robo Coronario-Subclavio/cirugía , Isquemia Miocárdica/etiología , Complicaciones Posoperatorias/etiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Síndrome de Robo Coronario-Subclavio/cirugía , Anastomosis Quirúrgica/métodos , Angina de Pecho/fisiopatología , Recuperación de la FunciónRESUMEN
Roubo coronariano da subclávia (RCS) é um fenômeno raro que ocorre em pacientes submetidos a cirurgia de revascularização miocárdica com enxerto de artéria torácica interna esquerda (ATIE) e que causa estenose da artéria subclávia ipsilateral e proximal à origem da ATIE. Relatamos o caso de um paciente masculino de 65 anos que apresentou quadro atípico de síndrome do RCS, manifestando-se como síndrome coronariana aguda no pós-operatório de cirurgia vascular (AU)
Coronary subclavian steal (CSS) is a rare phenomenon that occurs in patients undergoing coronary artery bypass graft surgery using the left internal thoracic artery (LITA) causing stenosis of the ipsilateral subclavian artery proximal to the origin of the LITA. We report the case of a 65-year-old male patient who presented with atypical CSS syndrome, manifesting as acute coronary syndrome after vascular surgery (AU)
Asunto(s)
Humanos , Masculino , Anciano , Síndrome Coronario Agudo/etiología , Síndrome de Robo Coronario-Subclavio/cirugía , Arteria Carótida Interna/cirugía , Circulación Coronaria , Vasos Coronarios/fisiopatología , Endarterectomía Carotidea/efectos adversos , Revascularización Miocárdica/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugíaRESUMEN
Late onset of angina pectoris associated with subclavian artery (SA) atherosclerotic occlusive disease is a rare and recognized cause of myocardial ischemia when the lesion is proximal to a left internal mammary artery (LIMA) to coronary bypass. The symptoms typically exacerbate by increasing the flow demand in the extremity; this phenomenon is known as late coronary-subclavian steal syndrome. We describe the case of a 66-year-old woman who underwent coronary artery bypass grafting from the LIMA to the left anterior descending coronary artery in 2000. Years later, she experienced refractory angina pectoris associated to an occlusive lesion in the proximal left SA. SA endarterectomy with eversion technique and subclavian-carotid transposition restored the antegrade flow with resolution of the symptomatology.
Asunto(s)
Angina de Pecho/etiología , Síndrome de Robo Coronario-Subclavio/cirugía , Endarterectomía , Anciano , Síndrome de Robo Coronario-Subclavio/complicaciones , Femenino , HumanosRESUMEN
Coronary subclavian steal syndrome is a rare but important condition that occurs after a left internal mammary artery (LIMA) to coronary artery bypass in the setting of a stenotic left subclavian artery. The lack of blood flow through the subclavian artery causes the reversal of flow in the LIMA so that it essentially steals blood from the myocardium. In order to avoid this complication, many surgeons now opt to either revascularize the stenotic subclavian artery prior to coronary artery bypass grafting or to use an alternate vessel as the bypass graft. Here, we present the case of an asymptomatic patient with poor exercise tolerance who was recently diagnosed with both triple-vessel coronary disease and peripheral arterial disease, which was most notably characterized by occlusion of the left subclavian artery. This case demonstrates the surgical management of this complex clinical entity.
Asunto(s)
Puente de Arteria Coronaria/métodos , Síndrome de Robo Coronario-Subclavio/cirugía , Intervención Coronaria Percutánea , Angiografía , Síndrome de Robo Coronario-Subclavio/diagnóstico , Ejercicio Físico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
In patients with mammary-coronary bypass grafts, the presence of a subclavian artery stenosis proximal to the internal mammary artery may result in a condition termed coronary-subclavian steal syndrome of which the incidence varies between 0.07-3.4% among those requiring coronary grafts. We reported a patient with a history of the coronary artery bypass graft who presented with typical angina pectoris at rest that was exacerbated by selective exercise of the left upper extremity in whom occlusion of the left subclavian artery was demonstrated in this patient by 3D reconstruction of computed tomography angiography, a reversal blood flow in the left internal mammary artery-left anterior descending artery graft by Doppler ultrasonography, and a coronary angiography.
Asunto(s)
Angina de Pecho/diagnóstico por imagen , Angiografía Coronaria , Puente de Arteria Coronaria/métodos , Síndrome de Robo Coronario-Subclavio/diagnóstico por imagen , Arteria Subclavia/diagnóstico por imagen , Anciano , Angina de Pecho/etiología , Síndrome de Robo Coronario-Subclavio/complicaciones , Síndrome de Robo Coronario-Subclavio/cirugía , Humanos , Masculino , Imagen Multimodal , Resultado del TratamientoAsunto(s)
Infarto de la Pared Anterior del Miocardio/diagnóstico , Infarto de la Pared Anterior del Miocardio/cirugía , Síndrome de Robo Coronario-Subclavio/diagnóstico , Síndrome de Robo Coronario-Subclavio/cirugía , Intervención Coronaria Percutánea , Puente de Arteria Coronaria/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Síndrome de Robo Coronario-Subclavio/cirugía , Intervención Coronaria Percutánea/métodos , Hipertensión/complicaciones , Obesidad/complicacionesRESUMEN
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.
Asunto(s)
Síndrome de Robo Coronario-Subclavio/diagnóstico , Arteria Subclavia/diagnóstico por imagen , Anciano , Angiografía , Síndrome de Robo Coronario-Subclavio/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Arteria Subclavia/cirugía , Tomografía Computarizada por Rayos X , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
Coronary-subclavian steal syndrome represents a reversal of blood flow in left internal mammary artery. The most common cause of the syndrome is atherosclerotic disease in the ipsilateral, proximal subclavian artery. We present a case of 72 years old male, who developed severe anginal and neurological complaints three years after coronary artery bypass graft surgery(CABG).
Asunto(s)
Síndrome de Robo Coronario-Subclavio/complicaciones , Isquemia Miocárdica/etiología , Anciano , Angina de Pecho/complicaciones , Angina de Pecho/terapia , Aorta Torácica/patología , Puente de Arteria Coronaria/efectos adversos , Síndrome de Robo Coronario-Subclavio/cirugía , Humanos , Masculino , Isquemia Miocárdica/cirugía , Stents , Arteria Subclavia/patologíaRESUMEN
Coronary subclavian steal syndrome is an unusual cause of myocardial ischemia, secondary to a reversed blood flow in patients with patent internal thoracic artery coronary bypass grafts. The causes of coronary subclavian steal are either ipsilateral subclavian artery stenosis or upper extremity arteriovenous hemodialysis fistula formation or both. This report involves a 68-year-old woman with left vertebral artery occlusion who developed severe coronary steal in the absence of vertebral subclavian steal due to left subclavian artery stenosis and an arteriovenous hemodialysis graft.
Asunto(s)
Derivación Arteriovenosa Quirúrgica/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Síndrome de Robo Coronario-Subclavio/diagnóstico por imagen , Diálisis Renal , Síndrome del Robo de la Subclavia/diagnóstico por imagen , Anciano , Síndrome de Robo Coronario-Subclavio/etiología , Síndrome de Robo Coronario-Subclavio/cirugía , Femenino , Humanos , Arterias Mamarias/diagnóstico por imagen , Arterias Mamarias/cirugía , Radiografía , Síndrome del Robo de la Subclavia/complicaciones , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/cirugíaRESUMEN
We describe a case of coronary-subclavian steal syndrome in a 77-year-old man who presented with progressive coronary ischemia 8 years after coronary artery bypass grafting with an in-situ left internal thoracic artery graft. Coronary and left subclavian artery angiogram revealed completely patent internal thoracic artery graft and 90% stenosis in the proximal left subclavian artery. We performed axilloaxillary artery bypass using expanded polytetrafluoroethylene (ePTFE)[8 mm] graft. No coronary ischemia was noted postoperatively. Axillo-axillary artery bypass grafting was effective for coronary subclavian steal syndrome.