Key result
Undetected left subclavian artery occlusion linked to pronounced ST-depression and hemodynamic instability upon bypass weaning.
Why the study?
Coronary-subclavian steal syndrome classically presents with upper limb exertion, and there are currently no recommendations for screening for subclavian artery stenosis prior to CABG.
Case Report (n=1)
Highlights the risk of intra-operative coronary-subclavian steal syndrome during CABG and proposes a preoperative screening algorithm for subclavian artery stenosis.
Alerts to coronary-subclavian steal risk during CABG weaning; hypothesis-generating for preoperative subclavian screening algorithms.
Coronary-subclavian steal syndrome (CSSS) describes the condition whereby haemodynamically significant proximal subclavian artery stenosis results in flow limitation or reversal within the left internal mammary artery (LIMA) graft, classically precipitated by upper limb exertion. We report an unusual presentation, where a patient developed pronounced ST-depression and haemodynamic instability immediately following weaning from bypass. The patient was subsequently found to have occlusion of their left subclavian artery. Despite its incidence, there are currently no recommendations for screening for subclavian artery stenosis. We propose a preoperative screening algorithm that may allow for intervention prior to CABG, enabling risk-free use of the LIMA.
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Mann et al. (2020) conducted a case report in Coronary-subclavian steal syndrome (n=1). Left subclavian artery occlusion was evaluated on Pronounced ST-depression and haemodynamic instability. Undetected left subclavian artery occlusion resulted in pronounced ST-depression and haemodynamic instability immediately following weaning from bypass.
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