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Coronary artery steal syndrome in patient after coronary arteries by-pass surgery and left subclavian artery stenting-is the maintenance of a patent internal mammary artery still necessary?

Rafal Januszek, Artur Dziewierz, Andrzej Brzychczy, Marcin Misztal, Dariusz Dudek

The use of the left internal mammary artery (LIMA) is preferred for the revascularization of a stenosed or occluded left anterior descending artery (LAD). Occlusion or stenosis of proximal part of the left subclavian artery (LSA) could induce reverse blood flow in LIMA called coronary subclavian steal syndrome (CSSS) and should be revascularized before coronary artery bypass grafting (CABG) surgery with LIMA. If restenosis of previously stented LSA occurs after CABG surgery with LIMA another revascularization is inevitable. However, the revascularization of LSA could reveal that increased blood pressure in LAD persistent through years due to present CSSS could substantially influence blood pressure change in coronary arteries and LIMA graft. This phenomenon can raise the question if it is necessary to maintain patent LIMA-LAD graft.