Prevalence and treatment of proximal left subclavian artery stenosis in patients referred for coronary artery bypass surgery

The left internal mammary artery (LIMA) is currently used in most coronary artery bypass graft (CABG) surgeries due to excellent long-term patency. Left subclavian artery stenosis (SAS) proximal to the LIMA origin can cause a steal syndrome leading to myocardial ischemia or LIMA failure. We retrospectively evaluated the records of 608 consecutive patients referred for CABG at our institution between October 1, 2004 and October 1, 2006 and identified 226 patients (37%) who underwent left subclavian angiography immediately after diagnostic coronary angiography. Significant left SAS was found in 6 of those 226 patients (2.7%). Subclavian angiography did not result in any complications. All left SAS lesions were successfully stented, followed by CABG surgery (using the LIMA artery) after 22 ± 7 days. Left subclavian angiography in patients referred for coronary artery bypass surgery has low risk and may identify a small proportion of patients with significant proximal left SAS. Stenting of proximal left SAS can be accomplished before CABG with low risk and excellent short-term outcomes.