J Lipid Atheroscler.  2014 Jun;3(1):39-42. 10.12997/jla.2014.3.1.39.

Patent Coronary Artery Bypass Graft (CABG) is not Sufficient for Myocardial Perfusion: Non-ST Elevation Myocardial Infarction Caused by Critical Subclavian Artery Stenosis

• Lee SA
• Kim JH
• Shin HS
• Lee HS
• Choi HM
• Lee HY

• KMID: 2198359
• DOI: http://doi.org/10.12997/jla.2014.3.1.39

Abstract

Myocardial revascularization using the left internal thoracic artery (LITA) has become a standard method for coronary artery bypass graft (CABG) surgery due to its long-term graft patency and lower repeated revascularization rate compared to a saphenous vein graft. The prevalence of significant subclavian artery stenosis was reported to be 0.2-6.8% in patients undergoing CABG surgery using LITA. We present a case of 49-year-old female patient who complained of resting chest pain and left arm pain after CABG surgery using the LITA. NSTEMI was caused by de novo subtotal left subclavian artery stenosis proximal to the LITA. The left subclavian artery was successfully stented, and the patient experienced complete relief of pain.

Keyword

Subclavian artery; CABG; Subclavian artery stenosis

MeSH Terms

Arm
Chest Pain
Coronary Artery Bypass*
Female
Humans
Mammary Arteries
Middle Aged
Myocardial Infarction*
Myocardial Revascularization
Perfusion*
Prevalence
Saphenous Vein
Stents
Subclavian Artery
Subclavian Steal Syndrome*
Transplants*

Figure

• 

  Fig. 1 Coronary angiography and Selective LIMA angiography. (A) Left coronary angiogram shows total occlusion of the left anterior descending artery and the left circumflex artery, (B) Right coronary angiogram shows critical diffuse stenosis of the right coronary artery, (C) Selective LIMA angiogram reveals patent CABGs to the left anterior descending artery, obtuse marginal branch and (D) the posterior descending coronary artery.

• 

  Fig. 2 Left subclavian artery angiography. (A) Left subclavian artery angiogram shows a tight stenosis in the ostium without contrast reflux into the ascending aorta, (B) Successful stenting to the ostium shows good patency to subclavian artery.

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