Hüseyin GÜNDÜZ, Ramazan AKDEMİR, Cenk TATAROĞLU, Cihangir UYAN

Subklavyan arterin beyin ve kalpten çalması: Olgu sunumu

Altmışsekiz yaşında erkek hasta koroner ve serebrovasküler yetmezlik bulguları ile müracaat etti. Sol kolun motor aktivitesi semptomların ortaya çıkmasına neden oluyordu. Hasta on sene önce koroner bypass ameliyatı geçirmişti ve bu yeni bulgular iki sene önce başlamıştı. Anjiyografik incelemede subklavyan arterin başlangıçta tam tıkalı olduğu ve sol internal mammaryan arter ile sol ön inerkoroner arterden, sol vertebral arterle de santral sinir sisteminden subklavyan distaline kaçak gözlendi. Koroner ve subklavyan çalma sendromunun her ikisinin de semptomlarının görülmesi klinikte nadir olarak rastlanılan bir durumdur.

Subclavian artery steal from both of heart and brain: Case report

We report a 68-year-old patient who pesented with symptoms of both coronary and cerebrovascular insufficiency. Physical activity of the left arm aggrevated the occurance of symptoms. He received a coronary bypass operation ten years ago and symptoms of double insufficiency started two years ago. Angiographic examination demonstrated total occlusion of the subclavian artery and stealing of subclavian artery from the left anterior descending artery via the left intrnal mammary artery and from brain via the left vertebral artery. Symptomatic coronary steal syndrome together with subclavian steal syndrome is a recognised but uncommon cause of coronary and cerebral ischemia.

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1) Gutierrez GR, Mahrer P, Aharonian N, Mansukhani P, Bruss J. Prevalence of subclavian artery stenosis in patients with peripheral vascular disease. Angiology 2001;52:18994.
2) Olsen CO, Dunton RF, Maggs PR, Lahey SJ. Review of coronary-subclavian steal following internal mammary artery-coronary artery bypass surgery. Ann Thorac Surg 1998;46:667-78.
3) Tuseth V, Hegland ³, Fjetland L,Nilsen DWT. Reversed flow in internal mammary artery conduit and vertebral artery with left subclavian artery occlusion causing angina and vertigo the coronary-subclavian steal syndrome. Int J Card 2001;79:311-4.
4) Marshall WG Jr, Miller EC, Kouchoukos NT. The coronary-subclavian steal syndroome: report of a case and recommendations for prevention and management. Ann Thorac Surg 1998;46:93-6.
5) Takach TJ, Reul GJ, Cooley DA. Concomitant occlusive disease of the coronary arteries and great vessels. Ann Thorac Surg 1998;65:79-84.
6) Takach TJ, Reul GJ, Gregoric I. Concomitant subclavian and coronary artery disease. Ann Thorac Surg 2001;71:187-9.
7) Fitzgibbon GM, Keon WJ. Coronary-subclavian steal : a recurrent case with notes on detecting the threat potential. Ann Thorac Surg 1995;60:1810-2.
8) Shapira S, Braun SD, Puram B. Percutaneous transluminal angioplasty of proximal subclavian artery stenosis after left internal mammary to left anterior descending artery bypass surgery. J Am Coll Cardiol 1991;18:1120-3.
9) Breall JA, Grossmann W, Stillmann IE. Atherectomy of the subclavian artery for patients with symptomatic coronary subclavian steal syndrome. J Am Coll Cardiol 1993;21:1564-7.