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# Coronary subclavian steal

Jules R. Olsthoorn · Niels Verberkmoes

Accepted: 21 February 2023 / Published online: 30 March 2023

© The Author(s) 2023

Coronary artery bypass grafting (CABG) is the cornerstone of treatment of patients with coronary artery disease [1]. The left internal mammary artery (LIMA) is the gold-standard conduit of choice because of its long-term patency [2]. In patients referred for surgery, atherosclerotic disease is not limited to the coronary arteries and often generalised in the vascular system. The presence of stenosis of the subclavian artery, before the LIMA, is an important problem in patients who have undergone CABG. In 1.0% of cases, this phenomenon occurs postoperatively and can lead to recurrent angina [3]. In extreme cases, as presented in the current report (Fig. 1 and see Video 1 in Electronic Supplementary Material), the flow through the LIMA can invert due to postoperative subclavian occlusion, causing ‘subclavian steal’. In most cases, patients exhibit angina after exercise of the upper extremities. Stenting of the subclavian artery or left subclavian artery bypass can be performed to treat this abnormality.

**Conflict of interest** J. R. Olsthoorn and N. Verberkmoes declare that they have no competing interests.

**Open Access** This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless

**Video online** The online version of this article contains one video (https://doi.org/10.1007/s12471-023-01772-5). The video can be found in the article back matter as “Electronic Supplementary Material”.

J. R. Olsthoorn (✉) · N. Verberkmoes

Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands

jules.olsthoorn@catharinaziekenhuis.nl

indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

## References

1. Fearon WF, Zimmermann FM, De Bruyne B, et al. Fractional flow reserve-guided PCI as compared with coronary bypass surgery. N Engl J Med. 2022;386:128–37.

2. Buxton BF, Hayward PA. The art of arterial revascularization—total arterial revascularization in patients with triple vessel coronary artery disease. Ann Cardiothorac Surg. 2013;2:543–51.

3. Tyras DH, Barner HB. Coronary-subclavian steal. Arch Surg. 1977;112:1125–7.

<figure><img src="image_2.png" /><figcaption>**Fig. 1** Still frame of postoperative coronary angiography showing retrograde filling of left mammary artery with steal in subclavian artery</figcaption></figure>

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