Wisneski Andrew D, Beyer Anna T, Shunk Kendrick A
San Francisco Veterans Affairs Medical Center, Department of Cardiology, 111C, 4150 Clement Street, San Francisco, CA 94121 USA.
J Invasive Cardiol. 2013 Jan;25(1):E14-6.
A 65-year-old man, s/p coronary bypass surgery (CABG) with left internal mammary artery (LIMA) to the left anterior descending (LAD) artery 12 years previously, presented to his local hospital with left upper extremity pain, dizziness, falls, and chest pain. At the outside hospital, a proximal total left subclavian occlusion was found and the patient underwent left subclavian artery to common carotid artery (SCA-CCA) bypass surgery. Shortly thereafter, the patient developed right subclavian thrombosis, and underwent right SCA-CCA bypass surgery. Twenty days later, coronary steal symptoms recurred; troponin levels were elevated and ultrasound exam revealed bilateral SCA-CCA graft occlusion. The patient was then transferred to a tertiary care facility with a diagnosis of non-ST elevation myocardial infarct (NSTEMI). A successful endovascular procedure was performed in the cardiac catheterization laboratory with the use of coronary chronic total occlusion (CTO) devices, to treat the coronary steal syndrome.
一名65岁男性，12年前接受了冠状动脉搭桥手术（CABG），使用左乳内动脉（LIMA）连接到左前降支（LAD）动脉，因左上肢疼痛、头晕、跌倒和胸痛前往当地医院就诊。在外院，发现左锁骨下动脉近端完全闭塞，患者接受了左锁骨下动脉至颈总动脉（SCA-CCA）搭桥手术。此后不久，患者出现右锁骨下静脉血栓形成，并接受了右SCA-CCA搭桥手术。20天后，冠状动脉窃血症状复发；肌钙蛋白水平升高，超声检查显示双侧SCA-CCA移植血管闭塞。随后，该患者被转至三级医疗机构，诊断为非ST段抬高型心肌梗死（NSTEMI）。在心脏导管实验室使用冠状动脉慢性完全闭塞（CTO）设备进行了一次成功的血管内手术，以治疗冠状动脉窃血综合征。
