Heart attack due to subclavian stenosis after CABG: a case r
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Subclavian artery stenosis occurs up to 4.6% in patients who are referred for a coronary artery bypass graft (CABG). Subclavian artery stenosis can compromise the blood flow in the ipsilateral mammary artery.

In this case report, the authors describe a patient with prior history of CABG and peripheral vascular disease, who presented with recurrent chest pain symptoms. Cardiac perfusion imaging using Rubidium-82 positron emission tomography showed extensive ischaemia in the anterior wall. Coronary angiography revealed an ipsilateral (left) severe subclavian stenosis, while there was no significant stenosis in the bypass grafts. Patient’s symptoms resolved after percutaneous intervention of the left subclavian artery.

Learning points
• Myocardial ischaemia due to subclavian artery stenosis is an important alternative diagnosis to coronary artery disease after coronary artery bypass graft.

• A history of peripheral vascular disease and a blood pressure difference between the upper extremities >15 mmHg are clinical predictors of subclavian artery stenosis.

• First-line treatment for subclavian stenosis is percutaneous revascularization.

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