PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY IN CORONARY INTERNAL THORACIC SUBCLAVIAN STEAL SYNDROME

Internal thoracic artery implants are widely used as conduits in coron ary artery bypass surgery because of their resistance to the developme nt of atherosclerosis. Two cases are reported of subclavian artery ste nosis proximal to the internal mammary artery in patients who had unde rgone coronary bypass surgery. In both cases, an atypical pattern of p ostsurgical angina developed, with retrosternal chest pain occurring s pecifically with upper extremities exercise. Coronary and graft angiog raphy revealed retrograde flow in the left internal thoracic artery du ring injection of the grafted coronary. Severe stenosis was identified in the subclavian artery. Treatment consisted of dilation of the subc lavian artery stenosis with stent placement in one patient. Both patie nts had marked symptomatic improvement after the procedure.