Coronary subclavian steal syndrome

Coronary subclavian steal syndrome arises when a stenosis of the subclavian artery results in reduced antegrade or retrograde flow in an internal mammary artery with resultant coronary ischemia. This occurs in patients who have previously undergone surgical coronary revascularization utilizing an internal mammary artery graft. This syndrome can be successfully treated percutaneously with excellent immediate and long-term results. As the standard femoral route may be difficult in the elderly patients due to iliacfemoral kinking and aortic tortuosity. In this June issue of the Journal of Geiratric Cardiology, Rigatelli et al. presented their experience to overcome these access difficulties through the brachial artery approach.1 The coaxial position of the catheter at the site of left subclavian artery stenosis was nearly perfect. Little amounts of contrast were used too. This report provides valuable lesson to peripheral interventionists. However, the total number of patient undergoing the procedure was small. The possibility of complications from the brachial artery approach is higher in patients older than 70 years. More works are needed to be done before this access can be claimed as the preferred approach for coronary subclavian steal syndrome in the elderly patients whenever it is possible and not contraindicated.