Coronary-subclavian steal syndrome (CSSS) is a clinical condition characterized by the reversal of blood flow in the left internal thoracic artery (ITA) in patients who have undergone coronary revascularization using this artery. It is a rare cause of myocardial ischemia subsequent to stenosis or occlusion of the subclavian artery (SA) proximal to ITA coronary bypass. Proximal subclavian artery (SA) stenosis is present and atherosclerotic disease is the underlying pathophysiologic mechanism in the majority of cases. We report a series of patients with late CSSS treated through an endovascular approach.Endovascular therapy with angioplasty and subclavian artery stenting is a treatment of choice for CSSS, due to the high success rates, minimally invasive procedure, and low morbidity and mortality rates. This condition should always be suspected in patients with a history of myocardial revascularization, clinical angina, and asymmetry between upper limb pulses.The use of left ITA for coronary artery revascularization has been associated with better long-term patency and patient survival than the use of a saphenous venous graft because in situ has superior patency rate and survival benefit when grafted to the left anterior descending artery. It is well known that each subclavian artery (SA) has four main branches, the ITA being one of them. The use of the ITA is better associated with long-term MR surgery due to being a conduit usually spared from atherosclerosis. However, this is not true for the proximal (“in flux”) part of this conduit, the subclavian artery, where atherosclerotic stenosis can affect the vessel. Atherosclerosis represents more than 90% of subclavian artery stenosis. Less common etiologies include arteritis (for example, Takayasu’s arteritis, giant cell arteritis), inflammation, radiation exposure, compression syndromes, fibromuscular dysplasia, and neurofibromatosis.]

With Best Regards,
Mark Williams
Journal Coordinator
Jounral of Vascular and Endovascular Therap