Ramazan AKDEMİR, Ekrem YETER, Harun KILIÇ, Uğur ARSLANTAŞ, Sadık AÇIKEL, Mehmet DOĞAN

Nadir bir koroner-subklaviyan çalma sendromu ve başarılı tedavisi

Elli bir yaşında bayan hasta göğüs ağrısı ve senkop yakınmasıyla kliniğimize başvurdu. İki yıl önce sol anterior desending artere (LAD) sol internal mammariyan arterin greft olarak kullanıldığı koroner bypass operasyonu uygulanmıştır. Elektrokardiyografinde prekordiyal T negatifliği vardı. Troponin değeri 0,15mg/dl e yükseldi. Koroner anjiyografisinde mid LAD arterde ciddi olmayan (%30) daralma ve distalinde azalmış kan akımı izlendi. Subklaviyam arterin ostiyumundan tam tıkandığı ve LAD’den IMA ile beyinden vertebral arter ile kan çaldığı görüldü. Subklaviyan artere perkütan anjiyoplasti ve stentleme sonrası distal LAD akımının düzeldi ve anjinal yakınmaları geçti.

Unique case of coronary-subclavian steal syndrome and successful treatment

A 51 year-old woman presented with chest pain and syncope. She has underwent a coronary artery bypass surgery using left internal mammary graft to the left anterior descending coronary (LAD) artery two years ago. Electrocardiography showed nonspecific T wave inversion in anterior leads. Troponin was elevated to 0,15 mg/dl. Coronary angiogram revealed a non critical (30%) stenosis in the mid LAD artery, and the flow distal to lesion was diminished. Subclavian artery was totally occluded at the level of ostium and stealing blood from LAD via LIMA and from brain via left vertebral artery. Percutaneous subclavian angioplasty and stent implantation to the left subclavian artery stenosis restored normal flow to the distal LAD artery and total relief of angina.

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