A rare reason of myocardial ischemia: left subclavian artery stenosis after coronary artery bypass grafting

Necmettin Çolak,

doi:10.5606/tgkdc.dergisi.2013.5320

Necmettin Çolak¹, Yunus Nazlı¹, İsmail Kırbaş², Beyhan Eryonucu³, Ömer Çakır¹

¹Department of Cardiovascular Surgery, Medical Faculty of Fatih University, Ankara, Turkey
²Department of Radiology, Medical Faculty of Fatih University, Ankara, Turkey
³Department of Cardiology, Medical Faculty of Fatih University, Ankara, Turkey

DOI : 10.5606/tgkdc.dergisi.2013.5320

A 57-year-old male was admitted with the complaint of prolonged resting angina. His medical history revealed coronary artery bypass grafting (CABG) two years ago. Electrocardiography showed sinus rhythm with a complete left bundle branch block without ST-depression or elevation. Subsequent exercise treadmill testing revealed a significant ST depression in V4-V6 leads. Coronary angiography showed patent bypass grafts, but a critical stenosis of the left subclavian artery just proximal to the origin of the left internal mammary artery. A stent was successfully implanted into the left subclavian artery. It should be considered that subclavian artery stenosis may cause coronary-subclavian steal, leading to myocardial ischemia in patients with a history of coronary artery bypass grafting utilizing a left internal mammary artery.

Keywords : Coronary artery bypass grafting; left subclavian artery stenosis; myocardial ischemia

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