Percutaneous Treatment of Refractory Angina Secondary to Left Subclavian Artery Stenosis in Patients after Coronary Artery Bypass Grafting

Abstract

Anginal chest pain is usually related to atherosclerotic coronary artery disease and its clinical presentation differs depending on the pathological aspects of the lesions. Left subclavian artery stenosis (SAS) as a cause of angina pectoris (AP) is often reported in patients with a history of coronary artery bypass grafting through left internal mammary artery (LMA) involved in the process of subclavian stenosis1. Very often, this diagnosis may be overlooked especially when patients are asymptomatic and present ischemic abnormalities on scintigraphy. Subclavian stenosis may also be associated with neurological symptoms by virtue of reversal of the flow through the vertebral artery due to subclavian hypotension. This is the case of a patient who underwent coronary artery bypass grafting with LMA for anterior descending artery (ADA) not involved in the subclavian stenosis and typical growing anginal pain related to physical exertion with the upper limbs or predominant involvement of the limbs. Stent-assisted percutaneous correction of the ostial and subtotal subocclusion of the left subclavian artery (LSA) made the patient asymptomatic.