THE CORONARY SUBCLAVIAN STEAL SYNDROME - AN UNCOMMON SEQUEL TO INTERNAL MAMMARY-CORONARY ARTERY BYPASS-SURGERY

Coronary subclavian steal syndrome is a possible sequel in patients wh o have undergone myocardial revascularization with an internal mammary artery. We report a case of this syndrome in a 67-years-old man. In 1 990 he underwent a quadruple bypass: aorta-obtuse margin, aorta-right coronary (twosequential), internal artery mammary-descending coronary artery. Three months later he started to have angina pectoris. In Apri l 1992 an aortic arch angiography and a coronary angiography were perf ormed. The examination showed an occlusion of the left subclavian arte ry at its origin. The artery was opacified countercurrently by the lef t vertebral artery but the left mammary artery was not opacified. Left coronary angiography showed a very severe disease of left anterior de scending coronary artery and retrograde flow through the anastomosis i n the left mammary artery. The patient underwent a left common carotid -subclavian artery bypass operation using a 6 mm vascutex graft. Eight een months later the patient is doing well without angina pectoris and with very little alteration of the perfusion in the left frontal lobe observed by SPECT neuroimaging with a Lipophilic tracer (Tc-99m-HMPAO ). We think that the coronary-subclavian steal syndrome can be treated successfully with low risk by means of common carotid-subclavian arte ry bypass.