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冠状动脉搭桥手术后急性ST段抬高型心肌梗死：一例经皮介入成功治疗的冠状动脉锁骨下动脉窃血综合征（CSSS）

ACUTE ST ELEVATION MYOCARDIAL INFARCTION FOLLOWING BYPASS GRAFT SURGERY: A CASE OF CORONARY SUBCLAVIAN STEAL SYNDROME (CSSS) SUCCESSFULLY TREATED WITH PERCUTANEOUS INTERVENTION.

作者信息

Mustapić Vito, Predrijevac Mladen, Dilber Dario, Rotkvić Luka, Škopljanac Mačina Andrija, Šesto Igor, Štambuk Krešimir

机构信息

Magdalena Clinic for Cardiovascular Disease, Krapinske Toplice, at Faculty of Medicine, JJ Strossmayer University in Osijek, Croatia.

School of Medicine of the University of Split, Croatia.

出版信息

Acta Clin Croat. 2024 Mar;63(Suppl1):96-100. doi: 10.20471/acc.2024.63.s1.18.

DOI:10.20471/acc.2024.63.s1.18
PMID:40599462
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12207845/
Abstract

Coronary subclavian steal syndrome (CSSS) is an uncommon complication of coronary artery bypass graft (CABG) surgery when the left internal mammary artery (LIMA) is used in patients with underdiagnosed significant left subclavian artery stenosis (SAS). It is characterized by a retrograde blood flow from coronary to subclavian circulation through LIMA graft, causing the "steal" phenomenon and myocardial ischemia. The common presentation is stable angina years after surgery and acute presentation with ST elevation early after surgery is extremely rare. Here we present an unusual and unique presentation of CSSS in a setting of acute ST elevation myocardial infarction treated successfully with complex percutaneous intervention.

摘要

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（CABG）的一种罕见并发症，当在左锁骨下动脉狭窄（SAS）未得到充分诊断的患者中使用左乳内动脉（LIMA）时就会发生。其特征是血液通过LIMA移植物从冠状动脉循环逆行至锁骨下循环，导致“窃血”现象和心肌缺血。常见表现是术后数年出现稳定型心绞痛，术后早期出现ST段抬高的急性表现极为罕见。在此，我们报告一例CSSS的不寻常且独特的表现，该患者在急性ST段抬高型心肌梗死的情况下通过复杂的经皮介入治疗成功治愈。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/22086955fda9/acc-63_supp1-96-f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/ae0bf709b09a/acc-63_supp1-96-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/326dba66f68f/acc-63_supp1-96-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/21ca5d8dd873/acc-63_supp1-96-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/a17a7376cb7f/acc-63_supp1-96-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/d103d3b871ab/acc-63_supp1-96-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/22086955fda9/acc-63_supp1-96-f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/ae0bf709b09a/acc-63_supp1-96-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/326dba66f68f/acc-63_supp1-96-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/21ca5d8dd873/acc-63_supp1-96-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/a17a7376cb7f/acc-63_supp1-96-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/d103d3b871ab/acc-63_supp1-96-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7346/12207845/22086955fda9/acc-63_supp1-96-f6.jpg

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本文引用的文献

1
Atrial fibrillation as a contributing factor in the diagnostic algorithm for coronary subclavian steal syndrome and cardiac tamponade following coronary artery bypass graft surgery: a case study.心房颤动是冠状动脉旁路移植术后诊断锁骨下动脉窃血综合征和心脏压塞的辅助因素：病例研究。
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Coronary Subclavian Steal Syndrome: A Contemporary Review.冠状动脉锁骨下窃血综合征：当代综述。
Cardiology. 2020;145(9):601-607. doi: 10.1159/000508652. Epub 2020 Jul 10.
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2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS).
2017年欧洲心脏病学会（ESC）与欧洲血管外科学会（ESVS）合作制定的外周动脉疾病诊断和治疗指南：涵盖颅外颈动脉和椎动脉、肠系膜、肾、上肢和下肢动脉粥样硬化疾病的文件 认可机构：欧洲卒中组织（ESO） 欧洲心脏病学会（ESC）和欧洲血管外科学会（ESVS）外周动脉疾病诊断和治疗特别工作组
Eur Heart J. 2018 Mar 1;39(9):763-816. doi: 10.1093/eurheartj/ehx095.
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Coronary Subclavian Steal Syndrome and Acute Anterior Myocardial Infarction: A New Treatment Dilemma in the Era of Primary Percutaneous Coronary Intervention.冠状动脉锁骨下动脉窃血综合征与急性前壁心肌梗死：在直接经皮冠状动脉介入治疗时代的新治疗困境
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Coronary subclavian steal syndrome.冠状动脉锁骨下动脉盗血综合征
Curr Opin Cardiol. 2014 Nov;29(6):506-13. doi: 10.1097/HCO.0000000000000109.
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Coronary Subclavian Steal Syndrome: An Unusual Cause of Angina in a Post-CABG Patient.冠状动脉锁骨下动脉窃血综合征：冠状动脉旁路移植术后患者心绞痛的一种罕见病因。
Case Rep Cardiol. 2014;2014:769273. doi: 10.1155/2014/769273. Epub 2014 Apr 29.
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Ann Surg. 2010 Jul;252(1):166-70. doi: 10.1097/SLA.0b013e3181e3375a.
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Ann Thorac Surg. 2010 Apr;89(4):1146-50. doi: 10.1016/j.athoracsur.2010.01.007.
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Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization.接受诊断性心导管检查患者左锁骨下动脉狭窄的血管造影患病率及临床预测因素
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