Usmanij Edwin A, Senden P Jeff, Meiss Louis, de Klerk John M H
Department of Nuclear Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, AT, Dordrecht, The Netherlands.
Department of Cardiology, Meander Medical Centre, Maatweg 3, TZ, Amersfoort, The Netherlands.
Eur Heart J Case Rep. 2018 Jun 2;2(2):yty069. doi: 10.1093/ehjcr/yty069. eCollection 2018 Jun.
Subclavian artery stenosis occurs up to 4.6% in patients who are referred for a coronary artery bypass graft (CABG). Subclavian artery stenosis can compromise the blood flow in the ipsilateral mammary artery.
In this case report, we describe a patient with prior history of CABG and peripheral vascular disease, who presented with recurrent chest pain symptoms. Cardiac perfusion imaging using Rubidium-82 positron emission tomography showed extensive ischaemia in the anterior wall. Coronary angiography showed an ipsilateral (left) severe subclavian stenosis, while there was no significant stenosis in the bypass grafts. Patient's symptoms resolved after percutaneous intervention of the left subclavian artery.
The presence of subclavian artery stenosis can result in myocardial ischaemia after prior CABG utilizing the internal mammary artery. A history of peripheral vascular disease and a blood pressure difference between the upper extremities greater than 15 mmHg are clinical predictors of subclavian artery stenosis. Percutaneous angioplasty and stenting is considered the first-line treatment for subclavian artery stenosis. Surgical management should be considered after failure of endovascular treatment in low-surgical-risk patients.
在接受冠状动脉旁路移植术（CABG）的患者中，锁骨下动脉狭窄发生率高达4.6%。锁骨下动脉狭窄会影响同侧乳内动脉的血流。
在本病例报告中，我们描述了一名有冠状动脉旁路移植术和周围血管疾病病史的患者，该患者出现反复胸痛症状。使用铷-82正电子发射断层扫描进行的心脏灌注成像显示前壁广泛缺血。冠状动脉造影显示同侧（左侧）严重锁骨下动脉狭窄，而旁路移植血管中无明显狭窄。经皮介入治疗左侧锁骨下动脉后患者症状缓解。
锁骨下动脉狭窄的存在可导致先前使用乳内动脉进行冠状动脉旁路移植术后出现心肌缺血。周围血管疾病病史以及双上肢血压差大于15 mmHg是锁骨下动脉狭窄的临床预测指标。经皮血管成形术和支架置入术被认为是锁骨下动脉狭窄的一线治疗方法。对于手术风险低的患者，血管内治疗失败后应考虑手术治疗。
