Acute ST Elevation Myocardial Infarction Following Bypass Graft Surgery: A case of Coronary Subclavian Steal Syndrome (CSSS) Successfully Treated with Percutaneous Intervention

Abstract

Coronary subclavian steal syndrome (CSSS) is an uncommon complication of coronary artery bypass graft (CABG) surgery when the left internal mammary artery (LIMA) is used in patients with underdiagnosed significant left subclavian artery stenosis (SAS). It is characterized by a retrograde blood flow from coronary to subclavian circulation through LIMA graft, causing the “steal” phenomenon and myocardial ischemia. The common presentation is stable angina years after surgery and acute presentation with ST elevation early after surgery is extremely rare. Here we present an unusual and unique presentation of CSSS in a setting of acute ST elevation myocardial infarction treated successfully with complex percutaneous intervention.

Keywords

• Coronary subclavian steal syndrome
• Subclavian artery occlusion
• Coronary artery bypass graft surgery
• Acute myocardial infarction with ST segment elevation
• Percutaneous intervention