CORONARY-SUBCLAVIAN STEAL SYNDROME - REPORT OF A CASE TREATED WITH SUBCLAVIAN ANGIOPLASTY

We describe the case of a man aged 42 who, five years before, had unde rgone aortocoronary bypass surgery using the internal mammary artery f or the anterior and saphenous vein graft for the posterior descending arteries. Over the last one and a half years he had started to present angina pectoris as well as symptoms of vertebrobasilar insufficiency during exertion of the left upper extremity (recently during simple wr iting), whereas a full treadmill test was normal. Clinically, obstruct ion of the left subclavian artery was suspected with both coronary and subclavian steals. This suspicion was confirmed with tripler of the v essels of the aortic arch, coronary arteriography and carotid arteriog raphy which demonstrated severe obstruction of the left subclavian art ery at its origin and reversal of blood flow through the ipsilateral v ertebral artery and the internal mammary artery graft. Angina subsided after balloon angioplasty of the subclavian artery. This combined ste al, termed coronary subclavian syndrome, is rare (our case is probably the 20th reported), but an increase of its incidence is anticipated d ue to the widespread use of internal mammary artery grafts. The preven tion and treatment of this syndrome are discussed.