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(Circulation. 2002;105:e184.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Angiographic Evidence of Coronary-Subclavian Steal Syndrome

C.R. Kroll, MD; M. Agarwal, MD; G.A. Stouffer, MD

From the Division of Cardiology, University of North Carolina, Chapel Hill.

Correspondence to George A. Stouffer, MD, Division of Cardiology, University of North Carolina, Chapel Hill, NC 27599-7075. E-mail rstouff{at}med.unc.edu

A 49-year-old man who had undergone coronary artery bypass grafting 16 months earlier presented with complaints of increasing angina pectoris. Initial angiography of the left coronary artery showed that contrast dye went retrograde up the left internal mammary artery (LIMA) and into the subclavian artery (Figure, A). Competitive flow was observed in the chest wall branches of the LIMA. Angiography demonstrated a severe obstruction of the left subclavian artery (Figure, B) with poor opacification of the artery distal to the stenosis and minimal appearance of contrast dye in the vertebral artery or LIMA. After stent placement (Figure, C), the subclavian artery, vertebral artery, and LIMA were all opacified by antegrade flow. This case demonstrates angiographic evidence of flow from the coronary system into the subclavian artery and supports prior reports of the existence of coronary-subclavian steal syndrome in patients with LIMA grafts and subclavian disease.

View larger version (115K): [in this window] [in a new window]   A, Angiography of the left coronary artery and LIMA in a right anterior oblique cranial projection. The figure is a composite of 2 images obtained during the same injection. The arrow points to the subclavian artery. B, Angiography of the left subclavian artery in an anterior-posterior projection. C, Angiography of the left subclavian artery in an anterior-posterior projection after stent placement. Vert indicates vertebral artery.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kroll, C.R. Articles by Stouffer, G.A. Search for Related Content PubMed PubMed Citation Articles by Kroll, C.R. Articles by Stouffer, G.A. Related Collections Peripheral vascular disease CV surgery: coronary artery disease