Intraoperative diagnosis and successful management of acute coronary–subclavian steal syndrome during off-pump coronary artery bypass grafting: a case report - Scorecard - MDSpire

Intraoperative diagnosis and successful management of acute coronary–subclavian steal syndrome during off-pump coronary artery bypass grafting: a case report

  • By

  • Da Gong

  • Fuqiang Zhang

  • Jin Wang

  • May 15, 2026

  • 0 min

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Clinical Scorecard: Intraoperative Identification and Effective Treatment of Acute Coronary-Subclavian Steal Syndrome During Off-Pump Coronary Artery Bypass Grafting: A Case Study

At a Glance

CategoryDetail
ConditionCoronary-Subclavian Steal Syndrome (CSSS)
Key MechanismsReversed blood flow in the left internal mammary artery (LIMA) due to significant left subclavian artery stenosis.
Target PopulationPatients undergoing coronary artery bypass grafting (CABG) with potential subclavian artery stenosis.
Care SettingIntraoperative setting during off-pump CABG.

Key Highlights

  • Acute CSSS is a rare complication during CABG, typically presenting later.
  • Intraoperative diagnosis was made using transit-time flow measurement (TTFM).
  • Immediate LIMA graft reconstruction effectively addressed the condition.
  • Significant stenosis of the left subclavian artery can lead to myocardial ischemia.
  • Prompt surgical decision-making is crucial in managing intraoperative complications.

Guideline-Based Recommendations

Diagnosis

  • Utilize transit-time flow measurement (TTFM) for intraoperative flow evaluation.
  • Monitor for inter-arm systolic blood pressure discrepancies exceeding 15 mmHg.

Management

  • Reconstruct LIMA graft if retrograde flow is detected.
  • Consider alternative conduits if subclavian pathology is suspected.

Monitoring & Follow-up

  • Regularly assess cardiac biomarkers and hemodynamic status postoperatively.

Risks

  • Potential for myocardial ischemia and arrhythmias due to CSSS.

Patient & Prescribing Data

Patients with significant coronary artery disease undergoing CABG.

Early identification and management of CSSS can prevent severe complications.

Clinical Best Practices

  • Conduct preoperative ultrasonography of supra-aortic branches in elective CABG.
  • Implement intraoperative flow assessments to detect complications early.
  • Be prepared for urgent interventions in case of intraoperative myocardial ischemia.

Related Resources & Content

Original Source(s)

Intraoperative diagnosis and successful management of acute coronary–subclavian steal syndrome during off-pump coronary artery bypass grafting: a case report

  • by Da Gong, Fuqiang Zhang, Jin Wang

  • May 15, 2026

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