Peer-review started: May 9, 2016
First decision: June 13, 2016
Revised: July 23, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: January 26, 2017
Processing time: 257 Days and 15.2 Hours
In patients with history of coronary artery disease angina pectoris is usually attributed to the progression of atherosclerotic lesions. However, in patients with previous coronary artery bypass graft operation (CABG) using internal mammary artery grafts, great vessel disease should also be considered. Herein we present two patients with history of CABG whose symptoms were suspicious for coronary ischemia. During cardiac catheterization reverse blood flow was observed from the left artery disease to the left internal mammary artery (LIMA) graft in both cases. After angioplasty and stent implantation of the left subclavian artery antegrade flow was restored in the LIMA grafts and both patients had complete resolution of symptoms.
Core tip: Both coronary and peripheral artery diseases are comorbidities with increasing morbidity and mortality. In patients with history of coronary artery disease and previous coronary revascularization, angina pectoris is usually attributed to the progression of atherosclerotic lesions. However, in patients who previously underwent coronary artery bypass graft operation (CABG) using internal mammary artery grafts, subclavian artery disease should also be considered. Herein we present 2 patients who previously underwent CABG with symptoms of myocardial ischemia due to subclavian artery stenosis.