This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lelek, M. Articles by Trusz-Gluza, M. Search for Related Content PubMed Articles by Lelek, M. Articles by Trusz-Gluza, M. Related Collections Acute coronary syndromes Peripheral vascular disease Coronary imaging: angiography/ultrasound/Doppler/CC

Images and Case Reports in Interventional Cardiology

Unstable Angina as a Result of Coronary-Subclavian Steal Syndrome

Michal Lelek, MD; Tomasz Bochenek, MD; Janusz Drzewiecki, MD, PhD and Maria Trusz-Gluza, MD, PhD

From the I Department of Cardiology, Medical University of Silesia, Katowice, Poland.

Correspondence to Tomasz Bochenek, MD, I Department of Cardiology, Medical University of Silesia, Ziolowa Street 45-47, 40-635 Katowice, Poland. E-mail tbochun@poczta.onet.pl

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 75-year-old man was transferred to our department from the local hospital because of recurrent episodes of dyspnea and angina at rest, with significant 3.0-mV ST-segment depressions in ECG leads V₃ through V₆. His medical history was significant for coronary artery disease, 2-vessel coronary artery bypass grafts (1999), nondisabling stroke (2004), type 2 diabetes mellitus, hypertension, and peripheral vascular disease. The patient also complained of dizziness and weakness of the left hand. Clinical examination was characterized by lack of radial pulse, and blood pressure could not be measured on the left arm. The echocardiogram showed apex and inferior wall hypokinesis with slightly diminished ejection fraction (50%).

Ultrasound examination revealed occlusion of the left internal carotid artery and reversed flow through the left vertebral artery, confirmed by angiography (Figure 1). Symptomatic vertebral-subclavian steal syndrome was diagnosed.

View larger version (158K):   Figure 1. Contrast injection into the brachiocephalic trunk and reversed flow through the left vertebral artery in late phase. The figure is a composite of 2 images obtained during different phases of the same injection: early- and late-phase contrast filling.

 
Angiography of the left coronary artery showed the entire left internal mammary artery (LIMA) graft (Figure 2) with reversed flow of contrast into the subclavian artery. The right and circumflex coronary arteries were occluded, as well as the venous graft to the right coronary artery. Contrast injection into the subclavian artery demonstrated critical 90% stenosis in the proximal part of the subclavian artery, with a translesion pressure gradient of 80 . . . [Full Text of this Article]