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Left subclavian artery stenosis with subclavian–subclavian bypass
  1. A Roguin,
  2. A W Heldman,
  3. R D Riley,
  4. I A Alhaddad

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An arch aortography demonstrates an occluded brachiocephalic trunk and subclavian–subclavian bypass graft (SSBG) in a 56 year old woman with left main and triple coronary artery disease requiring coronary artery bypass graft (CABG) surgery. A selective left subclavian arteriography revealed a moderate stenosis with a 40 mm Hg gradient proximal to the origin of the left vertebral artery and left internal mammary artery (LIMA). Stenting of the left subclavian stenosis was performed to improve distal flow and the utilisation of LIMA during CABG. To minimise cerebral embolisation of atherosclerotic material into the left vertebral artery and right carotid through the SSBG, left subclavian stenting was performed using induced hyperaemia of the left upper extremity and temporary manual compression of the SSBG. The procedure was uneventful and the patient was doing well one month later.

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