Angina as an indication for noncardiac surgery: the case of the coronary-subclavian steal syndrome.

Abstract

THE presence of angina in patients scheduled for noncardiac surgery is considered a risk factor for perioperative cardiovascular complications. 1 Myocardial revascularization is an effective treatment for angina; when performed before noncardiac surgery, it decreases cardiac complications compared with medical therapy Patients who undergo myocardial revascularization with internal mammary artery (IMA) grafting demonstrate longer survival and higher resolution of symptomatology when compared with patients with vein grafts. 4-6 The most common practice is to graft the distal end of the IMA to an epicardial coronary artery to allow antegrade flow to travel from the subclavian artery toward the heart. However, if stenosis of the subclavian artery proximal to the take off of the IMA is present, angina may occur as a result of coronary-subclavian steal. 7 If the stenosis includes the carotid artery, then symptoms of cerebral ischemia can occur concurrently, Here, we report the successful perioperative treatment of two patients diagnosed with unstable angina due to coronary-subclavian steal syndrome.