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Vol.5 , No. 4, Publication Date: Sep. 3, 2018, Page: 103-107
 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.&picture=http://www.aascit.org/aascit/decorators/img/journal/906.jpg)
| [1] | José Maciel Caldas dos Reis, Department of Vascular Surgery, University State of Pará, Belém, Brazil. |
| [2] | Fabio Akimaro Kudó, Department of Vascular Surgery, University State of Pará, Belém, Brazil. |
| [3] | Moisés do Carmo Bastos, Department of Vascular Surgery, University State of Pará, Belém, Brazil. |
| [4] | Ely Maria Neves de Sousa, Department of Cardiology, University State of Pará, Belém, Pará, Brazil. |
| [5] | Monna Hessen Banna de Oliveira, Department of Medicine, University State of Pará, Belém, Brazil. |
| [6] | 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.
Keywords
Coronary-Subclavian Steal Syndrome, Coronary Bypass, Internal Mammary Artery, Subclavian Stenosis, Myocardial Ischemia
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