Elsevier

The Annals of Thoracic Surgery

Volume 88, Issue 6, December 2009, Pages 2036-2038
The Annals of Thoracic Surgery

Case report
Subclavian Artery Thrombosis Associated With Acute ST-Segment Elevation Myocardial Infarction

https://doi.org/10.1016/j.athoracsur.2009.05.045Get rights and content

Presentation of acute ST segment elevation myocardial infarction in the setting of acute subclavian artery thrombosis in a patient who underwent coronary artery bypass grafting with a left internal mammary artery graft, which is not believed to have been previously described. We report a 75-year-old woman with presentations of dizziness, nausea, left-arm numbness, and a cold left hand, who later had chest pain develop. Acute ST segment elevation myocardial infarction was diagnosed, and both a computed tomography and an angiography disclosed a thrombus extending from the proximal portion of the left subclavian artery to the orifice of the left internal mammary artery. The patient was free from the previously listed symptoms after undergoing emergent thrombectomy, with complete extraction of the long thrombus from the subclavian artery. Unfortunately, she died of pneumonia and septic shock 11/2 months later.

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Comment

Coronary subclavian steal syndrome is rare in patients who have received coronary artery bypass grafting. This is caused by a retrograde blood flow through the LIMA to the vertebral and subclavian arteries, resulting from a stenosis over the proximal subclavian artery [1]. The prevalence of subclavian artery stenosis in patients having undergone coronary artery bypass grafting is approximately 0.5% to 1.1% [2, 3]. Typical manifestations include cardiac symptoms of angina and noncardiac symptoms

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  • A Unique Case of STEMI STEALing the Flow

    2020, JACC: Case Reports
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    Features of CSSS include angina or myocardial infarction resulting from reduced flow in the LIMA, a branch of the second part of the subclavian artery (1). Both non–ST-segment and ST-segment elevation myocardial infarction have been described with CSSS, although the latter is much rarer (2–5). The initial diagnosis of CSSS is usually by noninvasive imaging with duplex ultrasound, CT angiography, or magnetic resonance angiography.

  • Review of coronary subclavian steal syndrome

    2017, Journal of Cardiology
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    Presence of a significant proximal left subclavian artery stenosis (LSAS) can lead to functional LIMA graft failure despite having a disease-free graft by stealing of blood from the myocardium. This phenomenon is known as coronary-subclavian steal syndrome (CSSS) (Fig. 1) and its consequences include angina, acute coronary syndrome, new-onset and decompensated heart failure, and malignant ventricular arrhythmias [14–20]. These serious and potentially catastrophic implications behoove screening for subclavian artery stenosis (SAS) prior to CABG and continued active surveillance for the interval development of SAS post CABG [21,22].

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