Percutaneous transluminal angioplasty and stenting of proximal left subclavian artery stenosis in a patient with coronary-subclavian steal syndrome

Coronary-subclavian steel syndrome is a rare disease characterized by symptoms of myocardial ischemia, upper extremity claudication, and cerebrovascular insufficiency. A 57-year-old man who had undergone coronary artery bypass surgery with the use of a left internal mammary artery graft a year before developed angina pectoris of three-month history. He had complaints of increased chest pain induced by left arm movements and left arm incompetency. Physical examination showed a significant blood pressure difference between the right and left arms. Electrocardiography showed no recent ischemic changes. Cardiac enzymes were normal. On coronary angiography, vein grafts were patent. An aortogram showed proximal stenosis in the left subclavian artery and a selective subclavian angiogram showed diminished blood flow through the left internal mammary artery graft. Left subclavian artery angioplasty and stent implantation were performed, which resulted in complete patency of the left subclavian artery and sufficient re-flow through the graft. Subclavian steal syndrome disappeared.