eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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vol. 10

Short communication
Immediate improvement of left internal thoracic artery graft flow after subclavian artery stenting

Ahmet Goktug Ertem
Harun Kilic
Ugur Arslantas
Ekrem Yeter

Postep Kardiol Inter 2014; 10, 3 (37): 209–210
Online publish date: 2014/09/11
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A 65-year-old man was admitted to the emergency department with chest and arm pain ongoing for one hour. He had a history of anterior myocardial infarction (MI) with coronary artery bypass graft (CABG) operation (left anterior descending artery (LAD) – left internal thoracic artery (ITA), left circumflex artery (LCX) – radial artery, and right coronary artery (RCA) – saphenous vein conduits), diabetes mellitus (DM) with oral medication, and hypertension (HT). On physical examination there was weakness of left arm pulse and lower left arm blood pressure (90/60 mm Hg, right arm blood pressure was 140/90 mm Hg). His electrocardiography (ECG) revealed old left bundle branch block (LBBB) (Sgarbossa criteria: 2 points) (Figure 1). His laboratory findings showed increased troponin, creatinine kinase MB (CK-MB), and CK levels (50 ng/dl (normal range: < 0.06 ng/dl), 132 U/l (normal range: < 40 U/l), 1095 U/l (normal range: < 250 U/l), respectively), serum haemoglobin level 15.9 g/dl, and serum creatinine level 0.97 mg/dl. He was diagnosed as non-ST elevation myocardial infarction. Coronary angiography revealed reversed flow through the left ITA conduit. Consequently, the patient was diagnosed as having coronary steal syndrome. Aortography showed 99% stenosis of the left subclavian artery. After passing through the lesion with a guidewire by the anterograde route, we performed balloon dilatation, and balloon-expandable stent implantation for stenotic lesion. During the same procedure, control coronary left angiography revealed improvement of ITA flow (Figures 2 A–F). The patient was discharged after 5 days with optimal medication.
Copyright: © 2014 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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