Open AccessEvaluation of coronary subclavian steal syndrome using sestamibi imaging and duplex scanning with observed vertebral subclavian steal
Author(s) -
Rossum Alfred C.,
Steel Susan R.,
Hartshorne Michael F.
Publication year - 2000
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960230321
Subject(s) - medicine , subclavian steal syndrome , subclavian artery , vertebral artery , stenosis , radiology , blood flow , cardiology , angiography , duplex scanning , artery
Coronary subclavian steal is defined as retrograde blood flow from the myocardium through the internal mammary artery graft, secondary to a proximal subclavian artery stenosis. The incidence of this syndrome in patients undergoing internal mammary artery grafts for coronary artery bypass is estimated to be 0.44%. Angiography remains the definitive diagnostic test for confirming this condition. We describe a noninvasive method for evaluating coronary subclavian steal syndrome in a 57‐year‐old man, with a 50–55% subclavian stenosis confirmed by angiography. Noninvasive evaluation using duplex scanning demonstrated normal vertebral artery blood flow. Technetium 99m‐sestamibi ( 99m Tc) imaging confirmed a fixed anterolateral defect. When left‐arm isometric exercise was employed, retrograde vertebral artery blood flow was observed by Doppler imaging. A repeat 99m Tc‐sestamibi study documented an increase in tracer distribution in the anterolateral defect confirming reperfusion of the myocardium through the left internal mammary artery graft. The use of duplex scanning and 99m Tc‐sestamibi may serve as an adjunct in evaluating coronary subclavian steal syndrome as well as documenting transient vertebral subclavian steal in this patient population.