ISSN: 2375-3838
International Journal of Clinical Medicine Research  
Manuscript Information
Endovascular Therapy in Coronary-Subclavian Steal Syndrome: A Clinical Case
International Journal of Clinical Medicine Research
Vol.5 , No. 4, Publication Date: Sep. 3, 2018, Page: 103-107
636 Views Since September 3, 2018, 190 Downloads Since Sep. 3, 2018

José Maciel Caldas dos Reis, Department of Vascular Surgery, University State of Pará, Belém, Brazil.


Fabio Akimaro Kudó, Department of Vascular Surgery, University State of Pará, Belém, Brazil.


Moisés do Carmo Bastos, Department of Vascular Surgery, University State of Pará, Belém, Brazil.


Ely Maria Neves de Sousa, Department of Cardiology, University State of Pará, Belém, Pará, Brazil.


Monna Hessen Banna de Oliveira, Department of Medicine, University State of Pará, Belém, Brazil.


Ingrid Rodrigues de Oliveira Rocha, Department of Medicine, University State of Pará, Belém, Brazil.


Background: Coronary-subclavian steal syndrome (CSSS) is a clinical condition characterized by the reversal of blood flow in the internal mammary artery in patients who have undergone coronary revascularization using this artery. CSSS develops due to significant stenosis or proximal occlusion in the subclavian artery. It is a rare syndrome that is becoming increasingly significant because of the continuous use of the internal mammary artery in coronary revascularization. It presents clinically with cardiac ischemia and, more rarely, acute myocardial infarction. Objective: The authors describe the case of a patient who underwent coronary revascularization five years ago (in 2012) with the internal mammary artery and two more saphenous vein bridges, and recently (in 2017) presented with recurrent chest pain with irradiation to the back, related to physical activity, mainly involving the upper limbs. Method: On physical examination, he had no axillary, brachial, radial, and ulnar pulses on the upper left limb, and the blood pressure on the upper limbs was significantly different (on the right 130/70 mmHg and on the left 80/60 mmHg). He was diagnosed with CSSS. Myocardial scintigraphy was initially performed with a suggestive finding of an ischemic area on the anterior wall. Cardiac catheterization identified permeability of both bridges and absence of new lesions in the coronary arteries and identified ostial occlusion of the left subclavian artery. Results: He underwent angioplasty and balloon-expandable-stent implantation with complete remission of the symptoms. Conclusion: Therefore, the authors conclude that endovascular therapy with angioplasty and subclavian artery stenting is the treatment of choice for CSSS, due to the high success rates, minimally invasive procedure, and low morbidity and mortality rates, and this condition should always be suspected in patients with a history of myocardial revascularization, clinical angina, and asymmetry between upper limb pulses.


Coronary-Subclavian Steal Syndrome, Coronary Bypass, Internal Mammary Artery, Subclavian Stenosis, Myocardial Ischemia


Harjola PT, Valle M. The importance of aortic arch or subclavian angiography before coronary reconstruction. Chest. Vol. 66, No. 4, 1974, pp. 436-8.


Tariq S, Tuladhar S, Wingfield E, Poblete H. Coronary subclavian steal syndrome unamenable do angioplasty successfully managed with subclavian-subclavian bypass. Case Reports in Vascular Medicine. Vol. 2012, 2012, 784231.


Vogel JHB, Kristen A, Kloos W, Kohler B, Katus HA, Korosoglou G. Interventional treatment of the left subclavian in 2 patients with coronary steal syndrome. World Journal of Cardiology. Vol. 9, No. 1, 2017, pp. 65-70, ISSN 1949-8462 (online).


Cua B, Mandani N, Halpin D, et al. Review of coronary subclavian steal syndrome. Journal of Cardiology. Vol. 70, 2017, pp. 432-7.


Abdul Jabbar A, Houston J, Burket M, et al. Screening for subclinical subclavian artery stenosis before coronary artery bypass grafting: Should we do it? Echocardiography. 2017, pp. 1–6.


Rutherford RB. Vascular Surgery. 7a Edicão Philadelphia: Saunders; 2010; Gloviczki P, Kalra M. Chapter 61 Superior Vena Cava Obstruction: Surgical Treatment. In: Rutherford RB, et al., editors. Vascular Surgery. 7th Edition Philadelphia: Saunders, 2010, pp. 963-73.


Kim MS, Paeng JC, Kim KB, et al. Left carotid-to-subclavian artery bypass grafting for recurrent angina caused by coronary-subclavian steal syndrome. Korean The Journal of Thoracic and Cardiovascular Surgery. Vol. 46, 2013, pp. 84-7.


Sreckovic M, Jagic N, Miloradovic V, et al. Unusual suspect-coronary subclavian steal syndrome caused severe myocardial ischemia. Bosnian Journal of Basic Medical Sciences. Vol. 14, No. 1, 2014, pp. 45-7.


Westerband A, Rodriguez JA, Ramaiah VG, et al. Endovascular therapy in prevention and management of coronary-subclavian steal. Journal of Vascular Surgery. Vol. 38, 2003, pp. 699-704.


Fannari Z, Abraham N, Hammami S, et al. High-risk acute coronary syndrome in a patient with coronary subclavian steal syndrome secondary to critical subclavian artery stenosis. Case Reports in Cardiology. Vol, 2014, 2014, pp. 1-5.


Paty, et al. Surgical treatment of coronary subclavian steal syndrome with carotid subclavian bypass. Annals of Vascular Surgery. Vol. 17, 2003, pp. 22-6.


English JA, Carell ES, Guidera SA, et al. Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization. Catheterization and Cardiovascular Interventions. Vol. 54, 2001, pp. 8-11.


Miiller JC, Candemil PC, Loures JMGR, Zucco FM, Belz WE, Loures NGR, Ortiz LMR, Garcia RS. Síndrome do roubo coronário-subclávio: relato de caso e revisão da literatura. Jornal Vascular Brasileiro. Vol. 11, No. 2, 2012, 166-70.


Olsen C, Dunton R, Maggs P, Lahey S. Review of coronary-subclavian steal following internal mammary artery-coronary artery by-pass surgery. The Annals of Thoracic Surgery. Vol. 46, 1988, 675-8.


Bindea D, Todoran A, Mihai T, et al. Coronary-subclavian steal syndrome treated with carotid to subclavian artery by-pass. Chirurgia (Bucur). Vol. 108, 2013, pp. 264-7.


De Vries J, Jager L, van den Berg J, et al. Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long-term results. Journal of Vascular Surgery. Vol. 41, No. 1, 2005, pp. 19-22.


Faggioli G, Pini R, Cremonesi A, et al. Endovascular treatment of late coronary-subclavian steal syndrome. The Journal of Thoracic and Cardiovascular Surgery. Vol. 148, No. 5, 2014, 2112-6.


Takach TJ, Reul GJ, Cooley DA, et al. Myocardial thievery: The coronary subclavian steal syndrome. The Annals of Thoracic Surgery. Vol. 81, 2006, 386-92.


Guardado J, Goulão J, Pereira H, et al. Síndrome do roubo do miocárdio, a propósito de um caso clinico. Revista Porto Cardiologia. Vol. 24, 2005, 253-8.


Sağ S, Nas ÖF, Bedir Ö, Baran İ, Güllülü S, Hakyemez B. Coronary- subclavian steal syndrome in a hemodialysis patient with ipsila- teral subclavian artery occlusion and contralateral vertebral artery stenosis "Case Report". Anatol J Cardiol. Vol. 16, 2016, pp. 545-6.

  Join Us
  Join as Reviewer
  Join Editorial Board