Archivos de cardiología de México
Print version ISSN 1405-9940
ALCOCER, Alejandro et al. Anterograde flow compromise of a patent left internal mammary artery graft from a proximal subclavian artery stenosis. Myocardial ischemia not driven by the coronary-subclavian steal syndrome mechanism. Arch. Cardiol. Méx. [online]. 2012, vol.82, n.2, pp.135-138. ISSN 1405-9940.
A 54-year male with previous triple vessel coronary artery and aorto-bifemoral bypass graft surgeries complained of crescent angina. Stress induced myocardial ischemia on echocardiography was demonstrated. We performed direct stenting of a saphenous vein graft to the right coronary artery, via right radial approach. Subsequently stenting of a severe left subclavian artery proximal stenosis was performed via right brachial approach in order to relieve an overt myocardial ischemia in the territory supplied by a patent left internal mammary artery graft originated distally to the left subclavian stenosis. The finding of a total left axillary artery occlusion complement the pathogenesis of myocardial ischemia produced by limited anterograde flow and not driven by the common flow reversal mechanism of a typical coronary-subclavian steal syndrome.
Keywords : Coronary-subclavian steal syndrome; Saphenous vein bypass; Brachial artery approach; Direct stenting; Angioplasty; Multivascular intervention; Mexico.