Coronary subclavian steal syndrome: is there a need for rout
Coronary subclavian steal syndrome (CSSS) is an uncommon complication following cardiac bypass surgery involving the left internal mammary artery (LIMA).

Subclavian artery stenosis (SAS) proximal to the LIMA graft can result in retrograde blood flow and diminished myocardial perfusion. It is therefore important to suspect CSSS as a rare but important potential cause of chest pain and myocardial ischaemia in patients following coronary artery bypass graft (CABG) surgery.

The present case has been reported in the journal Oxford Medical Case Reports.

A 68-year-old male presented with abrupt central chest pain on waking with diaphoresis in the early hours of the morning. The pain did not radiate and was not relieved by glyceryl trinitrate spray. He denied any other symptoms. There were no upper or lower limb extremity symptoms (i.e. peripheral claudication, muscle fatigue, weakness, numbness) or cerebrovascular symptoms (i.e. syncope, headache, visual disturbances).

At the time of presentation, the patient had a past medical history of CABG surgery performed in 2002 for unstable angina. The LIMA was anastomosed to the diagonal artery, and three autologous long saphenous vein grafts to the: left anterior descending (LAD), right coronary artery (RCA) and obtuse marginal artery (OMA). Percutaneous coronary stenting of the vein graft to the proximal obtuse marginal was later performed successfully in 2011 for an acute coronary syndrome.

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