TREATMENT OF CORONARY-SUBCLAVIAN STEAL SYNDROME BY MEANS OF A CAROTID-SUBCLAVIAN BYPASS

Introduction. Coronary-subclavian steal syndrome is a rare cause of recurring angina that occurs in patients who have undergone coronary artery bypass surgery involving a left internal mammary artery (IMA) graft. A significant amount of stenosis or obstruction in the subclavian artery proximal to the origin of the IMA can limit the flow through the graft, or even invert it, which then causes myocardial ischaemia. Case report. We report the case of a 78-year-old female who had undergone heart surgery two and a half years earlier and who had a history of angina that was resistant to medical treatment, as well as electrocardiographic ischaemia in the territory of the anterior descending artery. An arteriography study confirmed the existence of an obstruction in the left subclavian artery proximal to the exit of the IMA. Endovascular treatment was attempted, although it was not effective, and so a carotid-subclavian bypass was performed, together with an endarterectomy in the right carotid artery, due to its being affected by preocclusive stenosis; results were satisfactory in both cases. Conclusions. With the increasingly frequent use of IMA as a graft for coronary revascularisation and the rising age of patients with concomitant vascular disorders, coronary-subclavian steal syndrome is becoming more and more common. The incidence of this condition can be reduced by proper selection and follow-up of patients before and after heart surgery. Percutaneous angioplasty and stent placement offer good results, but can give rise to complications such as embolisation or local dissection, which makes the classical carotidsubclavian bypass a safe alternative technique, with low morbidity and mortality rates and a high degree of long-term patency.