Treatment of an Unusual Occurrence of a Complex Left Subclavian Artery/Left Internal Mammary Artery Bifurcation Stenosis in the Setting of Coronary Subclavian Steal Syndrome and Ischemic Left Ventricular Systolic Dysfunction

Figures

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  Figure 1. SA angiogram showing diffuse, severe atherosclerosis of the SA/LIMA bifurcation. SA, subclavian artery; LIMA, left internal mammary artery.

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  Figure 2. Retrograde wiring of the SA via the left radial artery and anterograde wiring of the LIMA via the left femoral artery. SA, subclavian artery; LIMA, left internal mammary artery.

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  Figure 3. SA stented, trapping the LIMA wire. Persistent significant disease is noted in the proximal LIMA. SA, subclavian artery; LIMA, left internal mammary artery.

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  Figure 4. The DES is deployed in the LIMA with a balloon placed in the SA. The balloon will be inflated following stent deployment prior to concluding with final kissing angioplasty. DES, drug-eluting stent; LIMA, left internal mammary artery; SA, subclavian artery.

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  Figure 5. Final angiogram demonstrating a patent SA/LIMA bifurcation. SA, subclavian artery; LIMA, left internal mammary artery.

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  Figure 6. The Medina classification of coronary bifurcation lesions [11].