Vasigh Mostafa, Martinez Fidel, Ibeche Bashar, Huda Syed, Kozman Hani
Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA.
Cardiology, State University of New York Upstate Medical University, Syracuse, USA.
Cureus. 2020 Aug 17;12(8):e9797. doi: 10.7759/cureus.9797.
Coronary subclavian steal syndrome (CSSS) is one of the rare complications of coronary artery bypass graft surgery (CABG). This phenomenon is a potential complication after left internal mammary artery (LIMA) to left anterior descending artery (LAD) CABG. A proximal stenosis of the left subclavian artery (SA) could cause retrograde flow from LIMA to left SA, which characterizes the mechanism of CSSS. We describe a unique case of recurrent CSSS in a 64-year-old female who presented with one month of exertional dyspnea and acute onset chest pain. She had an extensive coronary artery disease history with CABG 15 years prior to presentation and CSSS treated with left SA stent placement nine years later. She also underwent percutaneous intervention with stents placed in the saphenous vein graft. Although electrocardiogram, cardiac enzymes, and stress test did not show any evidence of acute ischemic changes, perfusion scan detected large areas of partially reversible ischemia. Cardiac catheterization was performed, which showed in-stent restenosis of the left SA and retrograde flow from the LIMA to the left SA indicative of recurrence of CSSS. Left SA arteriogram confirmed in-stent restenosis of the left SA, which was treated with balloon angioplasty and stent placement.
冠状动脉锁骨下动脉盗血综合征（CSSS）是冠状动脉旁路移植术（CABG）罕见的并发症之一。这种现象是左乳内动脉（LIMA）至左前降支动脉（LAD）进行CABG术后的一种潜在并发症。左锁骨下动脉（SA）近端狭窄可导致血液从LIMA逆向流入左SA，这是CSSS的发病机制。我们描述了一例64岁女性复发性CSSS的独特病例，该患者出现劳力性呼吸困难1个月和急性胸痛。她有广泛的冠状动脉疾病史，在此次就诊前15年接受过CABG，9年后因CSSS接受了左SA支架置入治疗。她还接受了经皮介入治疗，在大隐静脉移植血管中置入了支架。尽管心电图、心肌酶和负荷试验均未显示任何急性缺血改变的证据，但灌注扫描发现大面积部分可逆性缺血。进行了心导管检查，结果显示左SA支架内再狭窄，且有血液从LIMA逆向流入左SA，提示CSSS复发。左SA血管造影证实了左SA支架内再狭窄，对其进行了球囊血管成形术和支架置入治疗。
