Zeleke Sinen Tadesse, Singh Davinder, Fletcher Alec, Saeed Izza, Rabbani Noor, Sayyed Rameez
Department Of Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA.
J Investig Med High Impact Case Rep. 2025 Jan-Dec;13:23247096251367580. doi: 10.1177/23247096251367580. Epub 2025 Sep 17.
Coronary-subclavian steal syndrome (CSSS) is a rare but important complication following coronary artery bypass grafting (CABG) involving the left internal mammary artery (LIMA), typically due to proximal subclavian artery stenosis. We present a 54-year-old male with prior triple-vessel CABG (LIMA to left anterior descending) who developed acute chest pain and elevated troponin levels. Electrocardiogram showed diffuse ST-segment changes. Emergent angiography revealed patent grafts but critical 90% stenosis of the left subclavian artery proximal to the LIMA origin. The lesion was successfully treated with percutaneous angioplasty and drug-eluting stent placement, resulting in the resolution of symptoms and preserved cardiac function. CSSS, though uncommon, should be considered in post-CABG patients with recurrent angina or myocardial injury despite patent grafts. Literature estimates subclavian stenosis in up to 5% of CABG candidates, yet routine screening remains inconsistent. This case highlights CSSS as a reversible cause of ischemia and underscores the value of targeted vascular imaging in selected patients.
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）涉及左乳内动脉（LIMA）后的一种罕见但重要的并发症，通常由于锁骨下动脉近端狭窄所致。我们报告一例54岁男性，既往接受过三支血管CABG（LIMA至左前降支），出现急性胸痛和肌钙蛋白水平升高。心电图显示广泛的ST段改变。急诊血管造影显示移植血管通畅，但在LIMA起始部近端的左锁骨下动脉存在90%的严重狭窄。该病变通过经皮血管成形术和药物洗脱支架置入成功治疗，症状得以缓解，心脏功能得以保留。CSSS虽然不常见，但对于CABG术后尽管移植血管通畅仍有复发性心绞痛或心肌损伤的患者应予以考虑。文献估计，在高达5%的CABG候选患者中存在锁骨下动脉狭窄，但常规筛查仍不一致。该病例突出了CSSS作为缺血的可逆性原因，并强调了在特定患者中进行靶向血管成像的价值。
