Percutaneous transluminal angioplasty of subclavian stenosis to improve inflow to internal mammary coronary arterial grafts.

Two cases are described of patients who previously had undergone myocardial revascularization with left internal mammary arterial (LIMA) grafts, who presented with recurrent cardiac symptoms and clinical evidence of left subclavian stenosis. Arteriography revealed significant subclavian stenosis with poor or absent filling of the LIMA grafts in both cases. Following successful percutaneous transfemoral angioplasty (PTA) of the lesions, there was improved flow in both LIMA grafts, with symptomatic improvement in both patients. There has been no evidence of re-stenosis at follow-up (2 and 5 years). Although rare, a promixal subclavian stenosis should be considered as a cause of recurrent symptoms in patients with previous LIMA grafts, causing a coronary Subclavian Steal syndrome. Percutaneous transfemoral angioplasty is a safe and effective treatment that can improve inflow through the graft.