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Herz

, Volume 40, Issue 2, pp 250–254 | Cite as

Coronary subclavian steal syndrome

A case-based review
  • I.D. KilicEmail author
  • Y.I. Alihanoglu
  • B.S. Yildiz
  • O. Taskoylu
  • H. Evrengul
Review article

Abstract

Internal mammary artery (IMA) grafts have been shown to be superior to saphenous vein grafts in terms of rare atherosclerotic involvement, biochemical and physical qualities, and long-term patency rates. The IMA originates from the subclavian artery, just distal to the vertebral artery, and an occlusion or a hemodynamically significant stenosis proximal to the IMA ostium would cause a pressure drop distally and a reversal of flow from the coronary arteries to the IMA in patients with this graft. This condition is referred to as “coronary subclavian steal syndrome” (CSSS). In most cases, the cause of this syndrome is atherosclerotic disease; however, other causes of subclavian artery stenosis (SAS) have the potential to lead to CSSS. Patients with CSSS present with the symptoms of myocardial ischemia due to coronary steal, vertebrobasilar insufficiency, or limb ischemia. Discrepancy in the blood pressure (BP) measurements in two arms should warn the clinician of SAS. A diminished pulse or the bruit of jet flow on the lesion side can be noticed. Doppler ultrasonography, computed tomography angiography, and magnetic resonance angiography are safe and accurate noninvasive modes of diagnosis. Treatment can be surgical or percutaneous.

Keywords

Coronary subclavian steal syndrome Internal mammary artery Subclavian artery stenosis Case report Review 

Koronares Subclavian-steal-Syndrom

Eine fallbasierte Übersicht

Zusammenfassung

Transplantate unter Verwendung der A. mammaria interna (IMA) sind nachgewiesenermaßen V.-saphena-Transplantaten überlegen, und zwar in Bezug auf eine seltene atherosklerotische Beteiligung, biochemische und physikalische Eigenschaften sowie die Langzeitraten für die Durchgängigkeit des Gefäßes. Die IMA entspringt aus der A. subclavia, direkt distal der A. vertebralis, und ein Verschluss oder eine hämodynamisch relevante Stenose proximal des Ostiums der IMA würde einen Druckabfall distal und eine Flussumkehr von den Koronararterien zur IMA bei Patienten mit einem solchen Transplantat verursachen. Diese Erkrankung wird als „koronares Subclavian-steal-Syndrom“ (CSSS) bezeichnet. In den meisten Fällen besteht die Ursache dieses Syndroms in einer Atherosklerose, allerdings können auch andere Ursachen einer Stenose der A. subclavia (SAS) zu einem CSSS führen. Patienten mit CSSS weisen infolge eines koronaren Steals, einer vertebrobasilären Insuffizienz oder einer Extremitätenischämie die Symptome einer Myokardischämie auf. Ein Blutdruckunterschied zwischen beiden Armen sollte dem Kliniker ein Warnhinweis auf das Vorliegen einer Stenose der A. subclavia sein. Es kann ein abgeschwächter Puls oder das Geräusch des Jetflusses auf der Seite der Läsion festzustellen sein. Dopplersonographie, Computertomographie-Angiographie und Magnetresonanz-Angiographie sind sichere und genaue nichtinvasive Diagnoseverfahren. Die Therapie kann chirurgisch oder perkutan erfolgen.

Schlüsselwörter

Koronares Subclavian-steal-Syndrom A. mammaria interna Stenose der A. subclavia Kasuistik Übersichtsarbeit 

Notes

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Copyright information

© Urban & Vogel 2013

Authors and Affiliations

  • I.D. Kilic
    • 1
    Email author
  • Y.I. Alihanoglu
    • 1
  • B.S. Yildiz
    • 1
  • O. Taskoylu
    • 2
  • H. Evrengul
    • 1
  1. 1.Medical Faculty, Department of CardiologyPamukkale UniversityDenizliTurkey
  2. 2.Servergazi State HospitalDenizliTurkey

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