Endovascular treatment of left subclavian artery occlusion in a patient after coronary artery bypass grafting. A case report
https://doi.org/10.15829/1728-8800-2026-4756
EDN: QNWLDM
Abstract
Introduction. Coronary artery disease remains the leading cause of death and disability worldwide. One treatment option is coronary artery bypass grafting (CABG) using the internal mammary artery (IMA). Subsequently, with left subclavian artery (LSA) occlusion or stenosis in patients after IMA grafting for CABG, angina symptoms may recur, leading to acute coronary syndrome (ACS), known as coronary subclavian steal syndrome (CSSS). This requires immediate revascularization. Endovascular intervention is the treatment of choice for symptomatic, hemodynamically significant LSA stenosis or occlusion.
Brief description. This case report presents a successful endovascular treatment of CSSS in a 59-year-old patient with multiple morbidities, which developed 9 years after CABG of the left anterior descending artery and presented with clinical symptoms of high-class angina. We described technical challenges of LSA stenting due to a single brachial approach and the need to maintain the patency of the mammary-coronary bypass graft.
Discussion. This case report demonstrates that endovascular LSA revascularization in CSSS is effective and safe. The potential for CSSS development highlights the need to include LSA assessment in the evaluation of patients after CABG using the IMA and the importance of timely revascularization.
About the Authors
N. N. Mislimova
Sakhalin Regional Clinical Hospital. Yuzhno- Sakhalinsk, Russia
Russian Federation
Russian Federation
Natalia N. Mislimova
Prospekt Mira, 430, Yuzhno-Sakhalinsk, 693004
A. N. Griazev
ГБУЗ "Сахалинская областная клиническая больница"
Russian Federation
Russian Federation
Andrey N. Griazev
Prospekt Mira, 430, Yuzhno-Sakhalinsk, 693004
References
1. Chong B, Jayabaskaran J, Jauhari SM, et al. Global burden of cardiovascular diseases: projections from 2025 to 2050. Eur J Prev Cardiol. 2025;32(11):1001-15. doi:10.1093/eurjpc/zwae281.
2. Barbarash OL, Karpov YuA, Panov AV, et al. 2024 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2024;29(9):6110. (In Russ.) doi:10.15829/1560-4071-2024-6110.
3. Shadman R, Criqui MH, Bundens WP. Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol. 2004;44(3):618-23. doi:10.1016/j.jacc.2004.04.044.
4. Walensi M, Bernheim J, Ulatowski N, et al. Atypical and rare cause of myocardial infarction: coronary subclavian steal syndrome (CSSS) treated by a carotid-subclavian bypass in a 71-year-old female patient. J Cardiothorac Surg. 2021;16(1):237. doi:10.1186/s13019-021-01625-5.
5. Bocharov AV, Popov LV, Mitsiev AK, et al. Subclavian artery stenting as a method of endovascular reduction of competitive blood flow in mammarocoronary shunt in the treatment of acute coronary syndrome without st segment elevation. Bulletin of the National Medical and Surgical Center named after N. I. Pirogov. 2022; 17(1):121-4. (In Russ.) doi:10.25881/20728255_2022_17_1_121.
6. Bocharov AV, Popov LV. Competitive blood flow: definition, biophysical basis, mechanisms of occurrence in clinical practice, clinical and angiographic diagnostic criteria. Clinical physiology of blood circulation. 2021;18(2):165-71. (In Russ.) doi:10.24022/1814-6910-18-2-165-171.
7. Petrosyan KV, Buziashvili YuI, Tugeeva EF, et al. Stenting of the left subclavian artery in a patient with recurrence of angina due to coronary-subclavian steal syndrome after mammarocoronary bypass surgery. Thoracic and Cardiovascular Surgery. 2018; 60(3):265-8. (In Russ.) doi:10.24022/0236-2791-2018-60-3-265-268.
8. Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024;45(36):3538-700. doi:10.1093/eurheartj/ehae179.
9. Liang S, Zhang A, Li F, et al. Clinical study of 57 cases of endovascular treatment for total subclavian artery occlusion. Vascular. 2025;33(3):556-66. doi:10.1177/17085381241254426.
10. Allenov AA, Shmatkov MG, Bazylev VV. Myocardial revascularization in a patient suffering recurrent angina pectoris caused by coronary subclavian steal syndrome following mammary coronary bypass surgery. Russian Journal of Endovascular Surgery. 2016;3(2):83-6. (In Russ.)
11. Przewlocki T, Wrotniak L, Kablak-Ziembicka A, et al. Determinants of long-term outcome in patients after percutaneous stent-assisted management of symptomatic subclavian or innominate artery stenosis or occlusion. EuroIntervention. 2017;13(11):1355-64. doi:10.4244/EIJ-D-17-00133.
12. Melkikyan AM, Papoyan SA, Gromov DG, et al. Results of endovascular treatment of subclavian arteries lesions. Journal of Diagnostic and Interventional Radiology. 2021;15(1):45-50. (In Russ.) doi:10.25512/DIR.2021.15.1.04.
- Left subclavian artery stenotic or occlusion after coronary artery bypass grafting (CABG) with internal mammary artery can lead to coronary subclavian steal syndrome.
- Coronary subclavian steal syndrome in a patient with a functioning graft requires immediate revascularization of the subclavian artery.
- Endovascular intervention is the treatment of choice for symptomatic, hemodynamically significant stenosis or occlusion of the subclavian artery.
Review
For citations:
Mislimova N.N., Griazev A.N. Endovascular treatment of left subclavian artery occlusion in a patient after coronary artery bypass grafting. A case report. Cardiovascular Therapy and Prevention. 2026;25(5):4756. (In Russ.) https://doi.org/10.15829/1728-8800-2026-4756. EDN: QNWLDM
Views:
249
JATS XML
Email this article 
