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Case Reports in Cardiology
Volume 2014, Article ID 769273, 6 pages
http://dx.doi.org/10.1155/2014/769273
Case Report

Coronary Subclavian Steal Syndrome: An Unusual Cause of Angina in a Post-CABG Patient

1Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA
2Cardiovascular Division, Clinical & Translational Research Center (CTRC), University at Buffalo, Suite 7030, 875 Ellicott Street, Buffalo, NY 14203, USA

Received 17 February 2014; Revised 25 March 2014; Accepted 26 March 2014; Published 29 April 2014

Academic Editor: Ramazan Akdemir

Copyright © 2014 Usman Younus et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Coronary subclavian steal syndrome is a rare complication of coronary artery bypass grafting surgery (CABG) when a left internal mammary artery (LIMA) graft is utilized. This syndrome is characterized by retrograde flow from the LIMA to the left subclavian artery (SA) when a proximal left SA stenosis is present. We describe a unique case of an elderly male who underwent CABG 6 years ago who presented with prolonged chest pain, mildly elevated troponins, and unequal pulses in his arms. A CTA of the chest demonstrated a severely calcified occluded proximal left SA jeopardizing his LIMA graft. Subclavian angiography was performed with an attempt to revascularize the patient’s occluded left SA which was unsuccessful. We referred the patient for nuclear stress testing which demonstrated a moderate size area of anterior ischemia on imaging; the patient exercised to a fair exercise capacity of 7 METS with no chest pain and no ECG changes. Subsequent coronary angiography showed severe native three-vessel coronary artery disease with intermittent retrograde blood flow from the LIMA to the left SA distal to the occlusion, jeopardizing perfusion to the left anterior descending (LAD) coronary artery distribution. He declined further options for revascularization and was discharged with medical management.