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Proximal Subclavian Artery Stenosis Diagnosis and Repair Documented by Both Myocardial Perfusion Imaging and Angiography

2004; Lippincott Williams & Wilkins; Volume: 109; Issue: 16 Linguagem: Inglês

10.1161/01.cir.0000127131.79178.80

1524-4539

Jesse J. Klein, Edward O. McFalls, Michael J. Cummings, Jianming Li,

Acute Myocardial Infarction Research

HomeCirculationVol. 109, No. 16Proximal Subclavian Artery Stenosis Diagnosis and Repair Documented by Both Myocardial Perfusion Imaging and Angiography Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBProximal Subclavian Artery Stenosis Diagnosis and Repair Documented by Both Myocardial Perfusion Imaging and Angiography Jesse J. Klein, DO, Edward O. McFalls, MD, PhD, Michael J. Cummings, MD and Jian-Ming Li, MD, PhD Jesse J. KleinJesse J. Klein From the University of Minnesota, Minneapolis (J.J.K.), and the Divisions of Cardiology (E.O.M., J.-M.L.) and Radiology (M.J.C.), Veterans Affairs Medical Center, University of Minnesota, Minneapolis. , Edward O. McFallsEdward O. McFalls From the University of Minnesota, Minneapolis (J.J.K.), and the Divisions of Cardiology (E.O.M., J.-M.L.) and Radiology (M.J.C.), Veterans Affairs Medical Center, University of Minnesota, Minneapolis. , Michael J. CummingsMichael J. Cummings From the University of Minnesota, Minneapolis (J.J.K.), and the Divisions of Cardiology (E.O.M., J.-M.L.) and Radiology (M.J.C.), Veterans Affairs Medical Center, University of Minnesota, Minneapolis. and Jian-Ming LiJian-Ming Li From the University of Minnesota, Minneapolis (J.J.K.), and the Divisions of Cardiology (E.O.M., J.-M.L.) and Radiology (M.J.C.), Veterans Affairs Medical Center, University of Minnesota, Minneapolis. Originally published27 Apr 2004https://doi.org/10.1161/01.CIR.0000127131.79178.80Circulation. 2004;109:e191–e193A 63-year-old man presented with a 3-month history of progressive angina relieved by rest. The chest pain worsened with exertion and radiated to his left arm. The use of his arms also exacerbated the pain. His medical history was significant for coronary artery disease, 4-vessel coronary artery bypass grafts (1997), mild hypertension, peripheral vascular disease, dyslipidemia, and type 2 diabetes mellitus. On admission, a 12-lead ECG and serial cardiac enzymes were negative for myocardial ischemia. An exercise thallium stress test demonstrated a large area of reversible ischemia in the anterior, septal, and apical walls (Figure 1). Subsequent cardiac catheterization surprisingly showed a widely patent left internal mammary artery and left anterior descending artery. The patient's aortic blood pressure was 220/100 mm Hg, whereas the blood pressure in his left arm was normotensive. Angiography performed in the aortic arch and great vessels verified significant proximal left subclavian artery stenosis (Figure 2). After reviewing the benefits and risks with the patient, left subclavian artery angioplasty and stent intervention were performed (Figure 3). A repeat exercise thallium stress test performed 2 days after the intervention demonstrated complete resolution of the ischemia (Figure 4). Six weeks later, the patient remained free of angina and left arm claudication. A sonogram was performed and revealed the left subclavian artery stent to be widely patent. Download figureDownload PowerPointFigure 1. Exercise thallium stress test images before angioplasty exhibiting significant reversible ischemia in the septal, anterior, and apical walls. Rows A and B are short-axis views of poststress and resting imaging, respectively. Rows C and D are vertical long-axis views of poststress and resting imaging, respectively. Rows E and F are horizontal long-axis views of poststress and resting imaging, respectively.Download figureDownload PowerPointFigure 2. Angiogram of the aortic arch and great vessels showing severe left proximal subclavian artery stenosis.Download figureDownload PowerPointFigure 3. A, Angiogram of the guidewire passing through the left proximal subclavian artery stenosis. B, Angiogram of the stent being deployed within the left proximal subclavian artery stenosis. C, Angiogram showing the resolution of the proximal subclavian artery stenosis after the angioplasty and stent deployment.Download figureDownload PowerPointFigure 4. Exercise thallium stress test after angioplasty and stent deployment demonstrating normal findings. Rows A and B are short-axis views of poststress and resting imaging, respectively. Rows C and D are vertical long-axis views of poststress and resting imaging, respectively. Rows E and F are horizontal long-axis views of poststress and resting imaging, respectively.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.FootnotesCorrespondence to Jian-Ming Li, MD, PhD, Veterans Affairs Medical Center, University of Minnesota, Division of Cardiology, One Veterans Dr, Minneapolis, MN 55417. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Suganthi L, Manivannan M, Kunwar B, Joseph G and Danda D (2014) Morphological analysis of peripheral arterial signals in Takayasu's arteritis, Journal of Clinical Monitoring and Computing, 10.1007/s10877-014-9572-8, 29:1, (87-95), Online publication date: 1-Feb-2015. Barlis P, Brooks M, Hare D and Chan R (2006) Subclavian artery occlusion causing acute myocardial infarction in a patient with a left internal mammary artery graft, Catheterization and Cardiovascular Interventions, 10.1002/ccd.20789, 68:2, (326-331), Online publication date: 1-Aug-2006. Jiménez R, Miñano-Pérez J, Bercial-Arias J, Seminario-Noguera I, González-Gutiérrez M, Morant-Gimeno F, Bernabeu-Pascual F, Moreno-De Arcos A and San Segundo-Romero E (2005) Síndrome de robo coronario-subclavio tratado mediante bypass carótido-subclavio, Angiología, 10.1016/S0003-3170(05)74931-2, 57:4, (357-363), Online publication date: 1-Jan-2005. Baba Y and Weerakkody Y (2014) Subclavian artery stenosis Radiopaedia.org, 10.53347/rID-29025 April 27, 2004Vol 109, Issue 16 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000127131.79178.80PMID: 15117864 Originally publishedApril 27, 2004 PDF download Advertisement