USE OF ANGIOPLASTY IN THE PREVENTION AND TREATMENT OF CORONARY-SUBCLAVIAN STEAL SYNDROME

PURPOSE: The coronary-subclavian artery steal (CSS) syndrome is caused by critical stenosis in the subclavian artery proximal to a bypass gr aft from the internal mammary artery (IMA) to the coronary artery. The stenosis results in retrograde flow in the IMA and steal from the cor onary artery. PATIENTS AND METHODS: Percutaneous transluminal angiopla sty (PTA) was performed in eight patients (five men, three women). In four patients (group 1), coronary ischemia had developed 0.5-70 months (mean, 31 months) after IMA-to-coronary artery bypass surgery. These four patients (mean age, 58 years; range, 44-68 years) underwent PTA o f a single area of focal subclavian stenosis to treat CSS. In four oth er patients (group 2), atherosclerotic subclavian stenosis had develop ed proximal to a donor IMA before planned bypass surgery. These patien ts (mean age, 53 years; range, 50-57 years) underwent PTA of a single focal subclavian stenosis to prevent CSS. RESULTS: Group 1 patients we re free of myocardial ischemia at follow-up (mean follow-up, 39.0 mont hs; range, 14-101 months). Three of four patients in group 2 underwent coronary artery bypass grafting with the ipsilateral IMA following PT A of the subclavian stenosis; they were free of angina at follow-up (m ean follow-up, 14 months; range, 10-18 months). CONCLUSION: PTA is a s afe and efficacious short-term method for prevention and treatment of CSS syndrome.