Case Reports
Early Onset of Coronary Subclavian Steal Syndrome: A Case Report and Literature Review
Jalal Gareeb, Farman J. Ahmed, Hemn H. Mohammad, Karokh F. Hamahussein, Soran H. Tahir, Sumaya Sabah Abdulrahman, Meer M. Abdulkarim, Suhaib H. Kakamad
IntroductionCoronary subclavian steal syndrome (CSSS) is a rare phenomenon that often goes undiagnosed and causes severe complications, including death. This report presents a case of CSSS with unexpectedly early presentation following coronary artery bypass grafting (CABG).
Case presentationA 49-year-old male with diabetes, smoking history, and ischemic heart disease underwent CABG with a left internal mammary artery graft to the LAD and saphenous vein grafts. Three months later, he presented with exertional chest pain and left arm discomfort. Examination revealed a significant inter-arm blood pressure difference (right 140/90 mmHg, left 90/65 mmHg) and a diminished left radial pulse. Computed tomography angiography revealed complete proximal left subclavian artery occlusion with patent grafts. Percutaneous revascularization with balloon pre-dilatation and a 7.0 × 27 mm stent restored flow. The procedure was uneventful, and at 10-month follow-up, he remained asymptomatic with normalized arm pressures.
Literature reviewA review of ten recent CSSS cases revealed a predominance of males (7/10), with ages ranging from 58 to 81 years. Comorbidities included cardiovascular, renal, and metabolic disorders. Chest pain was the most frequent presenting symptom. The interval from CABG to CSSS onset ranged from two days to 13 years. Management strategies encompassed percutaneous coronary interventions, nitrates, antihypertensives, and statins, with all patients achieving favorable outcomes.
ConclusionCoronary subclavian steal syndrome can present shortly after CABG. Percutaneous endovascular stenting via a dual approach might offer good long-term outcomes.
Keywords Coronary artery bypass grafting
· Coronary subclavian steal syndrome
· Heart
· Left internal mammary artery
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