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Walensi M, Bernheim J, Ulatowski N, Piotrowski M, Karaindros K, Juntermanns B, Mikat C, Heesen R, Hoffmann JN. Atypical and rare cause of myocardial infarction: coronary subclavian steal syndrome (CSSS) treated by a carotid-subclavian bypass in a 71-year-old female patient. J Cardiothorac Surg 2021; 16:237. [PMID: 34419122 PMCID: PMC8379753 DOI: 10.1186/s13019-021-01625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 08/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background 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). 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 presentation We 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. Conclusion CSB 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.
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Affiliation(s)
- Mikolaj Walensi
- Department of Vascular Surgery and Phlebology, CONTILIA Heart and Vascular Center, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany.
| | - Johannes Bernheim
- Department of Vascular Surgery and Phlebology, CONTILIA Heart and Vascular Center, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
| | - Nikodemus Ulatowski
- Department of Cardiothoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Michal Piotrowski
- Department of Emergency Medicine, William Osler Health System, Brampton, ON, Canada
| | - Konstantinos Karaindros
- Department of Vascular Surgery and Phlebology, CONTILIA Heart and Vascular Center, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
| | - Benjamin Juntermanns
- Department of Vascular Surgery and Phlebology, CONTILIA Heart and Vascular Center, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
| | - Christian Mikat
- Department of Radiology, Elisabeth Hospital Essen, Essen, Germany
| | - Roland Heesen
- Department of Angiology, CONTILIA Heart and Vascular Center, Elisabeth Hospital Essen, Essen, Germany
| | - Johannes N Hoffmann
- Department of Vascular Surgery and Phlebology, CONTILIA Heart and Vascular Center, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
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Unmasking the Coronary-Subclavian Steal Syndrome: The Culprit Lies in the Subclavian Artery. A Report of a Case and Review of the Literature. Ann Vasc Surg 2021; 74:524.e9-524.e15. [PMID: 33836226 DOI: 10.1016/j.avsg.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 11/20/2022]
Abstract
The coronary-subclavian steal syndrome is a hemodynamic phenomenon in which a subclavian artery stenosis or occlusion impairs blood flow at the origin of the left internal mammary artery used for coronary artery bypass grafting (CABG), causing retrograde blood flow and thus provoking symptoms of cardiac ischemia and its complications. Once considered the gold-standard operation of choice, open revascularization has now been abandoned as a first line treatment and replaced by endovascular techniques. In all cases, detailed and oriented physical examination in combination with further imaging in high clinical suspicion for coronary-subclavian steal syndrome remains the sine qua non of the preoperative examination of the patient. We report the case of a 50-year-old male patient suffering from acute onset angina post- coronary artery bypass grafting and managed by endovascular means.
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Chest Pain From a Different Etiology. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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