Left Subclavian Artery Thrombosis Causing Myocardial Ischemia in Patients With Prior Coronary Artery Bypass Grafting.

BACKGROUND

Acute subclavian artery thrombosis is a rare cause of myocardial ischemia in patients with prior coronary artery bypass grafting.

CASE SUMMARY: We present 2 cases of patients with left internal mammary artery (LIMA) to left anterior descending bypass grafts who developed cardiac ischemia secondary to acute thrombotic occlusion of the left subclavian artery. The first patient developed ventricular fibrillatory arrest after esophagectomy and the second patient had non-ST-segment elevation myocardial infarction in the setting of a recent colonoscopy. In both cases, left subclavian artery patency was reestablished following deployment of a covered stent. Antegrade flow to the LIMA to left anterior descending was restored with resolution of ischemic symptoms in both patients.

DISCUSSION: Acute thrombotic occlusion of the left subclavian artery is a rare cause of myocardial ischemia in patients with LIMA-dependent coronary circulation.

TAKE-HOME MESSAGE: Endovascular management with covered stent deployment is a feasible alternative to thrombectomy in this setting.