RESUMO
Coronary subclavian steal syndrome is an uncommon cause of angina in patients with a previous coronary artery bypass graft procedure. The patient had chest pain with the exertion of the left upper limb, difference in blood pressure between the left and right arm, occlusion at the ostium of the left subclavian artery. He underwent carotid subclavian bypass surgery that was successful in relieving symptoms. On the other hand, the patient had an embolic stroke related to the procedure and further assessment may be necessary.
Assuntos
Síndrome do Roubo Coronário-Subclávio , Síndrome do Roubo Subclávio , Masculino , Humanos , Síndrome do Roubo Coronário-Subclávio/diagnóstico por imagem , Síndrome do Roubo Coronário-Subclávio/cirurgia , Síndrome do Roubo Coronário-Subclávio/complicações , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Angina Pectoris/etiologiaRESUMO
Abstract The lateral costal artery has sometimes been identified as the culprit for the "steal phenomenon" after coronary artery bypass grafting, besides being occasionally used for myocardial revascularization. Its branches make anastomoses with the internal thoracic artery through lateral intercostal arteries. We aim to report, on three cases, the clinical significance of a well-developed lateral costal artery after coronary artery bypass grafting. Two out of three patients who underwent coronary artery bypass graft surgery in our center between June 2010 and August 2017, applied to us with stable angina pectoris, while the third one was diagnosed with acute coronary syndrome after applying to the emergency department. In coronary cineangiography, in all three cases, a well-developed accessory vessel arising from the proximal 2.5 cm segment of the left internal thoracic artery coursed as far as the 6th rib was detected, and it was confirmed to be the lateral costal artery. A stable angina pectoris in two of the patients was thought to be the result of steal phenomenon caused by the well-developed lateral costal artery. In the two cases with stable angina pectoris the lateral costal artery was obliterated via coil embolization. In the other case with the proximal left anterior descending artery stenosis, before percutaneous coronary intervention, the lateral costal artery was obliterated via coil embolization and the occluded subclavian artery was stented. Routine visualization in cineangiography and satisfactory surgical exploration of the left internal thoracic artery could be very helpful to identify any possible accessory branch of the left internal thoracic artery like the lateral costal artery.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Artérias Torácicas/anormalidades , Síndrome do Roubo Coronário-Subclávio/complicações , Anastomose de Artéria Torácica Interna-Coronária , Angina Pectoris/etiologia , Costelas/irrigação sanguínea , Artérias Torácicas/cirurgia , Cineangiografia , Síndrome do Roubo Coronário-Subclávio/cirurgia , Síndrome do Roubo Coronário-Subclávio/diagnóstico por imagem , Angina Pectoris/cirurgia , Angina Pectoris/diagnóstico por imagem , Revascularização MiocárdicaRESUMO
The lateral costal artery has sometimes been identified as the culprit for the "steal phenomenon" after coronary artery bypass grafting, besides being occasionally used for myocardial revascularization. Its branches make anastomoses with the internal thoracic artery through lateral intercostal arteries. We aim to report, on three cases, the clinical significance of a well-developed lateral costal artery after coronary artery bypass grafting. Two out of three patients who underwent coronary artery bypass graft surgery in our center between June 2010 and August 2017, applied to us with stable angina pectoris, while the third one was diagnosed with acute coronary syndrome after applying to the emergency department. In coronary cineangiography, in all three cases, a well-developed accessory vessel arising from the proximal 2.5 cm segment of the left internal thoracic artery coursed as far as the 6th rib was detected, and it was confirmed to be the lateral costal artery. A stable angina pectoris in two of the patients was thought to be the result of steal phenomenon caused by the well-developed lateral costal artery. In the two cases with stable angina pectoris the lateral costal artery was obliterated via coil embolization. In the other case with the proximal left anterior descending artery stenosis, before percutaneous coronary intervention, the lateral costal artery was obliterated via coil embolization and the occluded subclavian artery was stented. Routine visualization in cineangiography and satisfactory surgical exploration of the left internal thoracic artery could be very helpful to identify any possible accessory branch of the left internal thoracic artery like the lateral costal artery.
Assuntos
Angina Pectoris/etiologia , Síndrome do Roubo Coronário-Subclávio/complicações , Anastomose de Artéria Torácica Interna-Coronária , Artérias Torácicas/anormalidades , Idoso , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/cirurgia , Cineangiografia , Síndrome do Roubo Coronário-Subclávio/diagnóstico por imagem , Síndrome do Roubo Coronário-Subclávio/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Revascularização Miocárdica , Costelas/irrigação sanguínea , Artérias Torácicas/cirurgiaRESUMO
Coronary subclavian steal syndrome is a rare cause of recurrent angina after coronary artery bypass grafting. Identification of the myocardial ischemic region is crucial because it guides revascularization interventions to improve symptoms and myocardial ischemia. Positron emission computed tomography (PET) with rubidium might be a helpful tool because it identifies ischemia, localizes more precisely the ischemic region, and evaluates coronary flow reserve. Here, we report a case of recurrence of angina after coronary artery bypass grafting caused by an obstruction in the left subclavian artery and consequently by coronary steal syndrome confirmed by PET.