Carotid to Left Subclavian Artery Bypass Grafting for the Treatment of Coronary Subclavian Steal SyndromeNovel Teaching Points
Abdullah Baghaffar, MD, FRCSC,
Muhammed Mashat, MBBS,
Ryaan EL-Andari, BSc,
Bruce Precious, MD, FRCPC,
Hashem Aliter, MD,
Christine Herman, MD, FRCSC
Affiliations
Abdullah Baghaffar, MD, FRCSC
Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Division of Cardiac Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia; Corresponding author: Dr Abdullah Baghaffar, Division of Cardiac Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary, 2nd Floor, 2269-1796 Summer Street, Halifax, Nova Scotia B3H3A7, Canada. Tel: +1-902-223-6601; fax: +1-902-473-3808.
Muhammed Mashat, MBBS
Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Division of Cardiac Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
Ryaan EL-Andari, BSc
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
Bruce Precious, MD, FRCPC
Department of Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia, Canada
Hashem Aliter, MD
Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
Christine Herman, MD, FRCSC
Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
Recurrent angina after coronary artery bypass grafting is rarely caused by left subclavian artery (LSCA) stenosis resulting in reduced left internal mammary artery blood flow. We present 2 cases of coronary-subclavian artery steal syndrome resulting from LSCA stenosis and their successful surgical management with left carotid to LSCA bypass. Based on the successful management described in this case report, and the limitations of other options in addressing coronary-subclavian artery steal syndrome, left carotid to LSCA bypass surgery should be considered for revascularization in patients who develop postoperative coronary-subclavian artery steal syndrome due to LSCA stenosis. Résumé: La récidive d’angine après le pontage aortocoronarien est rarement causée par la sténose de l’artère sous-clavière gauche (ASCG) entraînant la réduction du débit sanguin de l’artère mammaire interne. Nous présentons deux cas de syndrome du vol coronaro-sous-clavier résultant de la sténose de l’ASCG et la réussite de leur prise en charge par pontage entre l’artère carotide gauche et l’ASCG. Compte tenu de la réussite de la prise en charge décrite dans cette observation et des limites des autres options dans le traitement du syndrome du vol coronaro-sous-clavier, le pontage entre l’artère carotide gauche et l’ASCG devrait être envisagé lors de la revascularisation des patients qui présentent le syndrome du vol coronaro-sous-clavier postopératoire en raison de la sténose de l’ASCG.
