Department of Cardiology, Augusta University Medical Center, 1120 15th Street, Augusta, GA 30912 USA.
J Invasive Cardiol. 2021 Feb;33(2):E145. doi: 10.25270/jic/20.00164.
Coronary subclavian steal syndrome (CSSS) is a complication incurred after coronary artery bypass grafting (CABG), characterized by retrograde blood flow through the left internal mammary artery (LIMA) graft to the left subclavian artery (SCA) distal to a SCA stenosis, thereby compromising myocardial perfusion from the LIMA despite its patency. We present a 40-year-old female with a history of triple-vessel CABG who presented with crescendo angina, notably when elevating her arms above her head. Atypical angina related to arm activity following successful LIMA bypass should prompt angiography directed to the left SCA, as well as to the LIMA graft. Typically, cases of CSSS are claudication dependent and not positionally related. This suggests a two-pronged pathophysiological mechanism of both demand ischemia and mechanical obstruction, which is not well described in previous literature.
冠状动脉锁骨下动脉窃血综合征（CSSS）是冠状动脉旁路移植术后（CABG）发生的一种并发症，其特征是血液通过左侧内乳动脉（LIMA）桥接血管逆行流至狭窄的左锁骨下动脉（SCA）远段，从而导致 LIMA 虽然通畅但仍存在心肌灌注不足。我们报告了一位 40 岁女性患者，有三血管 CABG 病史，表现为递增性心绞痛，尤其是当她将手臂举过头顶时。LIMA 旁路手术后与手臂活动相关的非典型心绞痛应提示行左 SCA 血管造影，以及 LIMA 桥接血管造影。典型情况下，CSSS 病例与跛行有关，与体位无关。这表明存在需求性缺血和机械性阻塞两种病理生理学机制，这在之前的文献中并未得到很好的描述。
