Coronary subclavian vertebral steal syndrome (CSVSS) is a rare but important complication of
coronary artery bypass graft surgery (CABG) when an internal mammary artery (IMA) is used. This
syndrome is defined as a retrograde flow from
coronary artery via the IMA and the
vertebral artery to the
subclavian artery due to a proximal
subclavian artery stenosis. We describe a case of a 64-year-old female who underwent CABG, complaining of dyspnea and chest pain by exercise of left arm, and dizziness when she turned her face to the left. Her blood pressure was 113/69 mmHg in the left arm and 137/84 mmHg in the right arm. Coronary angiography revealed retrograde flow from the left anterior descending (LAD) artery to the left IMA. Aortography showed that the ostium of the left
subclavian artery had a severe stenosis and that the left
vertebral artery was visualized retrogradely. Thereby, the diagnosis of CSVSS was made. The stenosis of the left
subclavian artery was successfully treated with a percutaneous transluminal angioplasty and stent implantation, resulting in the restoration of antegrade flow from the left IMA to the LAD artery and from the left
subclavian artery to the left
vertebral artery. She was discharged with no chest pain and dizziness.
<Learning objective: CSVSS is a rare but important complication of CABG. When patients who underwent CABG using IMA grafts complain of chest pain, arm claudication, or dizziness, physicians should suspect CSVSS. Proper physical examinations such as a difference in right and left blood pressure levels and a bruit of the subclavian area are needed.>