Abstract
BackgroundThe coronary subclavian steal syndrome (CSSS) is a rare complication after coronary arterial bypass graft operations (CABG) using the left or right internal mammary artery ((L/R)IMA). It results from a retrograde blood flow from the IMA into the subclavian artery (SA) due to a stenosis or occlusion of the SA proximal to the IMA origin. This “steal phenomenon” leads to a decreased blood flow in the IMA and may result in myocardial ischemia (MIS) and even myocardial infarction (MIN). Treatment options include interventional and surgical therapy.Case presentationWe report the case of a 71-year old woman, who suffered from an acute non-ST elevation myocardial infarction (NSTEMI) 11 years after LIMA-CABG surgery and who was treated successfully with a carotid-subclavian bypass (CSB) after failed interventional therapy.ConclusionCSB may be regarded as a viable treatment option for patients suffering CSSS in the case of MIS and even an acute MIN/NSTEMI, especially in the case of missing or failed interventional therapy attempts. Specialists in cardiothoracic and vascular surgery should be aware of possible CSSS conditions and know about appropriate diagnostic and therapeutic options.
Highlights
The coronary subclavian steal syndrome (CSSS) is a rare complication after coronary arterial bypass graft operations (CABG) using the left or right internal mammary artery ((L/R)IMA)
carotidsubclavian bypass (CSB) may be regarded as a viable treatment option for patients suffering CSSS in the case of myocardial ischemia (MIS) and even an acute myocardial infarction (MIN)/non-ST elevation myocardial infarction (NSTEMI), especially in the case of missing or failed interventional therapy attempts
Case presentation We report the case of a 71-year old female patient (165 cm, 83 kg) who was transferred to our department for vascular surgery with a CSSS-related acute NSTEMI in 05/2017
Summary
An advanced stage of the CSSS has been successfully treated with a CSB after failed interventional therapy, proving CSB to be a safe, feasible and effective therapeutic option. A CSB may be regarded as an excellent primary treatment option for patients suffering from CSSS, even in the case of an acute MIN and especially in the case of lacking or failed interventional therapy attempts as a secondary treatment option. We believe that knowledge about CSSS is crucial for cardiothoracic and vascular surgeons as in patients with a SA stenosis, who are undergoing CABG surgery as this may prevent iatrogenic CSSS and might as well necessitate to adjust the initially chosen therapeutic option for such patients
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