Publication Date
1-1-2023
Journal
Methodist DeBakey Cardiovascular J
DOI
10.14797/mdcvj.1239
PMID
37576086
PMCID
PMC10417913
PubMedCentral® Posted Date
8-9-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Humans, Aged, Subclavian Steal Syndrome, Theft, Coronary Artery Bypass, Subclavian Artery, Chest Pain, coronary subclavian steal, subclavian artery stenosis, computed tomography angiogram, subclavian artery angiogram, bilateral blood pressure differential
Abstract
A 70-year-old veteran with prior triple vessel coronary artery bypass grafting (CABG) presented with exertional chest pain. His work-up revealed > 40 mm Hg bilateral upper extremity blood pressure difference. Chest computed tomography and invasive angiography revealed severe stenosis at the ostium of the left subclavian artery, proximal to the origin of the left internal mammary artery to left anterior descending artery graft (LIMA-LAD). A diagnosis of coronary subclavian steal syndrome (CSSS) was made, and carotid-subclavian bypass was performed. This case outlines when to suspect CSSS, an approach to its diagnosis, and the importance of its timely management.