Case report identifies left subclavian artery stenosis causing ST elevation in aVR, highlighting the importance of investigating vascular lesions in post-CABG patients.
Background ST-segment elevation in lead aVR typically signifies left main or triple-vessel disease. In post-coronary artery bypass grafting (CABG) patients, this pattern, alongside patent grafts, necessitates investigating alternative causes of myocardial ischemia. Case presentation A 74-year-old male post-CABG presented with angina and ECG showing ST elevation in aVR with diffuse depression. Angiography revealed severe native coronary disease but patent grafts, including left internal mammary artery (LIMA) to left anterior descending artery. Persistent symptoms prompted further evaluation, which identified a critical left subclavian artery stenosis, compromising LIMA flow. Conclusion This case identifies left subclavian artery stenosis as a cause for aVR ST elevation in post-CABG patients by limiting LIMA graft inflow. It emphasizes the importance of evaluating extracoronary vascular lesions in recurrent ischemia despite patent grafts. Recognition and endovascular treatment of this condition can rapidly resolve symptoms and ECG abnormalities.
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Li et al. (2026) studied this question.
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