1/81. 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 = coronary (Clic here for more details about this article) |
2/81. Subclavian steal syndrome and flow-related aneurysm. Another reason to treat.A 48-year-old woman presented with a symptomatic right subclavian steal syndrome due to proximal subclavian artery stenosis. Anatomically the innominate artery was absent. collateral circulation followed the vertebro-vertebral pathway with reversal of blood flow in the ipsilateral vertebral artery. There was also multiple dilated intervertebral collaterals and an associated saccular aneurysm on one of them. Surgical carotid-subclavian transposition permitted relief of clinical symptoms, disappearance of collateral circulation and subtotal regression of the aneurysm. This spontaneous evolution confirmed the role of high-flow in the pathogenesis of some aneurysms and the habitually good prognosis of flow-related aneurysms with correction of the cause. Arteriography still appears essential in diagnosis, pretherapeutic assessment and sometimes post-treatment evaluation in subclavian steal syndrome.- - - - - - - - - - ranking = 0.11161418775933keywords = circulation (Clic here for more details about this article) |
3/81. coronary-subclavian steal syndrome: treatment with percutaneous transluminal angioplasty and stent placement.The aim of this study was to assess the efficacy of percutaneous transluminal angioplasty (PTA) and stenting in the management of the coronary-subclavian steal syndrome (CSSS). A 56-year-old man presented with CSSS due to occlusion of the left subclavian artery. He was treated with PTA and placement of two stents in the left subclavian artery. Systolic blood pressure became equal in both arms and dizziness disappeared. There were no complications. Percutaneous transluminal angioplasty and stenting can effectively and safely manage CSSS.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
4/81. 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 = 1.5keywords = coronary (Clic here for more details about this article) |
5/81. Relocation of the internal mammary artery graft in a case of coronary-subclavian steal.Reverse flow in the internal mammary artery coronary graft in the presence of subclavian stenosis is rare. We describe a 67-year-old man who 7 years after coronary artery surgery was admitted with left subclavian artery stenosis and retrograde flow in the pedicled left internal mammary artery graft. Subsequent redo triple coronary artery bypass grafts included regrafting the left internal mammary artery graft to a new vein conduit.- - - - - - - - - - ranking = 3.5keywords = coronary (Clic here for more details about this article) |
6/81. Evaluation of coronary subclavian steal syndrome using sestamibi imaging and duplex scanning with observed vertebral subclavian steal.Coronary subclavian steal is defined as retrograde blood flow from the myocardium through the internal mammary artery graft, secondary to a proximal subclavian artery stenosis. The incidence of this syndrome in patients undergoing internal mammary artery grafts for coronary artery bypass is estimated to be 0.44%. Angiography remains the definitive diagnostic test for confirming this condition. We describe a noninvasive method for evaluating coronary subclavian steal syndrome in a 57-year-old man, with a 50-55% subclavian stenosis confirmed by angiography. Noninvasive evaluation using duplex scanning demonstrated normal vertebral artery blood flow. technetium 99m-sestamibi (99mTc) imaging confirmed a fixed anterolateral defect. When left-arm isometric exercise was employed, retrograde vertebral artery blood flow was observed by Doppler imaging. A repeat 99mTc-sestamibi study documented an increase in tracer distribution in the anterolateral defect confirming reperfusion of the myocardium through the left internal mammary artery graft. The use of duplex scanning and 99mTc-sestamibi may serve as an adjunct in evaluating coronary subclavian steal syndrome as well as documenting transient vertebral subclavian steal in this patient population.- - - - - - - - - - ranking = 3.5keywords = coronary (Clic here for more details about this article) |
7/81. Isolated origin of the left subclavian artery from the left pulmonary artery.We describe two children with isolated origin of the left subclavian artery from the left pulmonary artery detected by echocardiography during the assessment of their congenital cardiac malformations. Both patients demonstrated pre-operative evidence of subclavian steal. This entity results from persistence of the dorsal segment of the sixth left arch, with regression of the left fourth arch and interruption of the left dorsal arch distal to the origin of the seventh left intersegmental artery. The significance of this finding relates to the potential for pulmonary overcirculation, which could have significant post-operative ramifications if not detected prior to surgical repair of an associated cardiac malformation. This entity differs from cases with a right aortic arch and aberrant left subclavian artery which has the potential to form a vascular ring, unlike cases with isolated origin of the left subclavian artery from the pulmonary artery that do not cause compression of the airway.- - - - - - - - - - ranking = 0.055807093879667keywords = circulation (Clic here for more details about this article) |
8/81. '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 = 1.5keywords = coronary (Clic here for more details about this article) |
9/81. 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 = 3keywords = coronary (Clic here for more details about this article) |
10/81. Revascularization of left subclavian artery for coronary subclavian steal syndrome.We have experienced 2 patients with coronary subclavian steal syndrome which progressed each to a different prognosis. Both cases received percutaneous transluminal angioplasty for subclavian artery stenosis after coronary artery bypass grafting. Although one case is doing well without any symptoms, the other case required axilloaxillary artery bypass grafting for the subclavian artery restenosis.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
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