1/38. Bilateral subclavian steal syndrome through different paths and from different sites--a case report.Cases of cerebro-subclavian steal syndrome have been reported in the medical literature since 1960. This most often occurs on the left side because of the higher rate of involvement of the left subclavian artery in comparison to the other brachiocephalic branches of the aortic arch. With the use of the internal mammory artery as a conduit for coronary artery bypass, in the past three decades increasing numbers of coronary-subclavian steal in addition to the cerebro-subclavian steal have been observed. The authors report a case of bilateral subclavian steal syndrome through both vertebral arteries, the right common carotid artery, and the left internal mammory artery, without significant signs and symptoms of cerebral ischemia or anginal pain.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
2/38. Coronary-subclavian steal associated with severe aortic stenosis treated with combined percutaneous stenting and minimally invasive aortic valve replacement.We describe coronary-subclavian steal restricting flow to the left internal mammary artery (LIMA) associated with critical aortic stenosis treated with combined percutaneous transluminal stenting and minimally invasive aortic valve replacement (AVR). An 86-year-old patient had coronary artery bypass graft placement (CABG) seven years prior with the LIMA anastomosed to the left anterior descending coronary artery (LAD). At the time of CABG, the patient had mild aortic stenosis and normal left ventricular function. By the time of re-presentation with refractory angina and heart failure, the patient had developed critical aortic stenosis. Because repeat CABG with median sternotomy risked damaging the LIMA, pre-operative revascularization was planned to minimize the likelihood of peri-operative ischemia. Stenting of the subclavian artery was performed prior to minimally invasive AVR.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
3/38. 'Cold hand, ischemic heart': treatment by stenting of the left subclavian artery.A 59-year-old man presented with worsening angina and a cold, painful left hand, eight years after coronary artery bypass surgery. coronary angiography showed extensive coronary atherosclerosis with blocked vein grafts to his left circumflex and right coronary arteries. There was a severe narrowing in the left subclavian artery before the origin of the left internal mammary artery (LIMA) which appeared patent. PTCA and stent implantation to the left subclavian artery stenosis restored normal flow to the left hand and the LIMA with abolition of his ischemic hand symptoms and marked improvement of his angina.- - - - - - - - - - ranking = 2keywords = angina (Clic here for more details about this article) |
4/38. Percutaneous transluminal laser guide wire recanalization of chronic subclavian artery occlusion in symptomatic coronary-subclavian steal syndrome.Treatment of subclavian artery stenosis by percutaneous balloon angioplasty and adjunctive stent placement was shown to be safe and efficacious, but it may be limited in tight stenoses and long occlusions. We describe the case of a patient who experienced progressive angina pectoris associated with signs of cerebrovertebral insufficiency 9 yr after bypass surgery, including left internal mammary artery (LIMA) grafting to the left anterior descending coronary artery. Angiography showed reversed flow through the LIMA graft into the subclavian artery and a 4-cm occlusion beginning at the origin of the left subclavian artery, representing a rare coronary-subclavian steal syndrome. After a conventional approach failed, recanalization was performed successfully using laser guide wire angioplasty with adjunctive stent placement in a combined radial and femoral approach.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
5/38. Reoperative revascularization of an occluded left subclavian artery and left internal mammary artery ostial stenosis.An ostial stenosis of the left internal mammary artery graft anastomosed to the left anterior descending artery was responsible for unstable angina in a patient with a previous coronary artery bypass graft. A T-shape arterectomy was performed between the left subclavian artery and left internal mammary artery. Successful revascularization of the lesion was achieved with a carotid-to-subclavian bypass and surgical ostial plasty extending to the proximal left internal mammary graft using a Hemashild a graft. This procedure was performed through a transverse supraclavicular incision to avoid potential hazards of a redo median sternotomy.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
6/38. Coronary subclavian steal syndrome: treatment by stenting of the left subclavian artery.A 48-year-old Turkish male presented with worsening angina and a painful left hand eight years after coronary artery bypass surgery. coronary angiography showed extensive coronary atherosclerosis with patent vein grafts to his diagonal branch and right coronary arteries. There was a severe narrowing lesion in the left subclavian artery before the origin of the left internal mammary artery (LIMA), which appeared patent. Percutaneous subclavian angioplasty and stent implantation to the left subclavian artery stenosis restored normal flow to the left hand and the LIMA with abolition of his ischemic hand symptom and marked improvement of his angina.- - - - - - - - - - ranking = 2keywords = angina (Clic here for more details about this article) |
7/38. Coronary subclavian steal syndrome after left internal mammary bypass in a patient with Takayasu's disease.We report the case of a 56-year-old symptomatic woman who underwent 2 coronary bypasses (left internal mammary artery on the left anterior artery and saphenous venous bypass on the circumflex) for a tight stenosis of the left main coronary. An inflammatory syndrome had been explored for 1 year without specific diagnosis. Eight months later, coronary angiography was performed for recurrence of angina: both bypasses were patent without stenosis and the left main stenosis was unchanged, but significant stenosis of the subclavian artery was found just before the LIMA. The diagnosis of Takayasu's disease was suspected in accordance with the ARC criteria and corticosteroids were started. One year later, because of recurrent angina, the patient was surgically treated with subclavian, vertebral and internal mammary endofibrectomy and an inverted saphenous vein graft from the subclavian to the axillary artery for extensive supra-aortic lesions. The patient remains symptom free at 1 year follow-up.- - - - - - - - - - ranking = 2keywords = angina (Clic here for more details about this article) |
8/38. Coronary steal from a left internal mammary artery coronary bypass graft by a left upper extremity arteriovenous hemodialysis fistula.In patients with end-stage renal disease undergoing hemodialysis, the upper extremity arteriovenous (AV) fistula is the dialysis access recommended by the DOQI guidelines for patients with appropriate vasculature. upper extremity AV fistulae have long periods of usefulness, high flow rates, and low associated complication rates. Placement of AV access may result in increased cardiac output and increased cardiac oxygen demand in these patients. In general, cardiovascular complications from AV access have been limited. We report a novel cardiovascular complication of AV access in an end-stage renal disease patient with a coronary artery bypass graft employing the left internal mammary artery who experienced angina while undergoing hemodialysis. The angina was mediated at least in part by cardiac catheterization laboratory-documented steal of blood flow from the internal mammary artery graft. This phenomenon suggests the need to consider the impact of upper extremity access placement on blood flow to the left internal mammary artery in patients who previously have undergone placement of a coronary artery bypass graft.- - - - - - - - - - ranking = 2keywords = angina (Clic here for more details about this article) |
9/38. Restenting for subclavian in-stent restenosis with symptomatic recurrent coronary-subclavian steal.PURPOSE: To determine whether restenting for recurrent coronary-subclavian syndrome is technically feasible, provides durable results, and is a reasonable alternative to surgery. CASE REPORT: A 58-year-old woman with a left internal mammary artery (LIMA) bypass to the left anterior descending artery underwent angioplasty and stent placement for left subclavian stenosis and coronary-subclavian steal. Twenty-three months later, she returned with progressive angina and left arm claudication; heart catheterization demonstrated restenosis of the subclavian artery at the stent site with recurrence of the coronary-subclavian steal. Successful redo angioplasty and stenting resulted in normal antegrade flow through the LIMA graft. The patient has remained asymptomatic for 3 years without evidence of recurrent in-stent stenosis on serial noninvasive studies. CONCLUSIONS: Restenting is technically feasible and appears to be a durable response to subclavian in-stent restenosis in patients with coronary subclavian steal.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
10/38. Tc-99m tetrofosmin myocardial SPECT combined with a modified exercise protocol in an unusual case of steal phenomenon.A 61-year-old diabetic woman was referred for myocardial perfusion single photon emission computed tomographic (SPECT) imaging 4 years after coronary artery bypass grafting to the left anterior descending (LAD) artery using a left internal mammary artery (LIMA) graft. She had 3 months' angina associated with fatigue of her left upper extremity (the patient is left-handed). Stress myocardial imaging using a Bruce protocol did not exhibit significant myocardial ischemia, but because of her typical angina symptoms, she underwent repeat stress myocardial imaging in combination with exercise of her left arm. During the aforementioned modified stress protocol, the patient reported angina, and radionuclide perfusion imaging showed extensive myocardial ischemia. The patient underwent coronary angiography and arteriography of the left subclavian artery, which revealed severe stenosis before the origin of the LIMA, resulting in reversed blood flow from the LAD artery through the LIMA graft to the left subclavian artery.- - - - - - - - - - ranking = 3keywords = angina (Clic here for more details about this article) |
| | Next -> |