REVIEW PAPER
Coronary subclavian steal syndrome
1
Department of Cardiology, Provincial Integrated Hospital in Elbląg, Poland
2
Department of Vascular and Internal Diseases, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
Submission date: 2025-06-15
Final revision date: 2026-01-05
Acceptance date: 2026-01-05
Online publication date: 2026-01-15
Corresponding author
Michał Jaśkiewicz
Department of Cardiology, Provincial Integrated Hospital in Elbląg, Królewiecka 146, 82-300 Elbląg, Poland.
Department of Cardiology, Provincial Integrated Hospital in Elbląg, Królewiecka 146, 82-300 Elbląg, Poland.
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Coronary subclavian steal syndrome (CSSS) is a rare occurring clinical problem concerning patients after coronary artery bypass grafting with use of left internal mammary artery (LIMA) with coexistence of significant stenosis or occlusion of left subclavian artery in proximal segment. This uncommon condition may have a significant impact on clinical outcomes of the cardiac surgery.
Aim:
Updating current medical knowledge about CSSS.
Material and methods:
A systematic review of recent literature on the topic.
Results and discussion:
Most cases of CSSS do not cause any symptoms due to other compensating mechanisms. However, in case of reverse flow occurrence in LIMA graft, patient can reveal picture of coronary syndrome, heart failure or arrhythmias. The stenosis of the subclavian artery usually is based on atherosclerosis. The diagnosis is based on clinical symptoms and radiology: ultrasonography, computed tomography and angiography. Most of the cases do not require any intervention. In symptomatic CSSS usually percutaneous angioplasty of subclavian artery is the first choice method of treatment.
Conclusions:
Considering growing population of patients after coronary artery bypass grafting and long live expectancy after this treatment, CSSS may be an increasing clinical problem, and still the awareness of it is not common among cardiologists. According to ESC guidelines, all patients referred to coronary artery bypass grafting with coincidence of peripheral atherosclerosis should routinely undergo aimed diagnostics towards potential subclavian artery stenosis.
Coronary subclavian steal syndrome (CSSS) is a rare occurring clinical problem concerning patients after coronary artery bypass grafting with use of left internal mammary artery (LIMA) with coexistence of significant stenosis or occlusion of left subclavian artery in proximal segment. This uncommon condition may have a significant impact on clinical outcomes of the cardiac surgery.
Aim:
Updating current medical knowledge about CSSS.
Material and methods:
A systematic review of recent literature on the topic.
Results and discussion:
Most cases of CSSS do not cause any symptoms due to other compensating mechanisms. However, in case of reverse flow occurrence in LIMA graft, patient can reveal picture of coronary syndrome, heart failure or arrhythmias. The stenosis of the subclavian artery usually is based on atherosclerosis. The diagnosis is based on clinical symptoms and radiology: ultrasonography, computed tomography and angiography. Most of the cases do not require any intervention. In symptomatic CSSS usually percutaneous angioplasty of subclavian artery is the first choice method of treatment.
Conclusions:
Considering growing population of patients after coronary artery bypass grafting and long live expectancy after this treatment, CSSS may be an increasing clinical problem, and still the awareness of it is not common among cardiologists. According to ESC guidelines, all patients referred to coronary artery bypass grafting with coincidence of peripheral atherosclerosis should routinely undergo aimed diagnostics towards potential subclavian artery stenosis.
FUNDING
None declared.
CONFLICT OF INTEREST
None declared.
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