Coronary-subclavian steal syndrome as a unique and overlooked cause of ST-T segment elevation myocardial infarction. Perfect cooperation between an invasive cardiologist and a vascular surgeon — a case report

Coronary-subclavian steal syndrome (CSSS) is a rare but significant complication of coronary artery bypass grafting (CABG) with left internal mammary artery (LIMA) to the left anterior descending artery (LAD), which can lead to secondary myocardial ischemia. We present the case of a 72-year-old female patient after CABG with LIMA, hospitalized due to ST-T segment elevation myocardial infarction (STEMI), in whom coronary angiography revealed patent all grafts to stenotic coronary arteries. Angiography also revealed stenosis of the left subclavian artery (LSA), and angioplasty with stenting of LSA restored normal flow in the LIMA and resolved the symptoms of ischemia. This case highlights the need to consider CSSS in the differential diagnosis of patients with symptoms of acute coronary syndrome (ACS) and patent LIMA. In patients scheduled for CABG, a thorough preoperative evaluation of the LIMA as a graft should be performed, including exclusion of LSA stenosis. The presented case is also an example of perfect cooperation between an invasive cardiologist and a vascular surgeon in the treatment of patients with complex vascular problems.