Myocardial ischaemia due to subclavian stenosis after coronary artery bypass graft: a case report

INTRODUCTION: 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. CASE PRESENTATION: In this case report, we 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 showed 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. DISCUSSION: The presence of subclavian artery stenosis can result in myocardial ischaemia after prior CABG utilizing the internal mammary artery. A history of peripheral vascular disease and a blood pressure difference between the upper extremities greater than 15 mmHg are clinical predictors of subclavian artery stenosis. Percutaneous angioplasty and stenting is considered the first-line treatment for subclavian artery stenosis. Surgical management should be considered after failure of endovascular treatment in low-surgical-risk patients.