Angiographic Evidence of Coronary-Subclavian Steal Syndrome
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.
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.
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