Canadian Journal of Cardiology
Case Report| Volume 35, ISSUE 10, P1419.e13-1419.e15, October 2019

Cardiogenic Shock After Arterial Y-Graft Coronary Bypass Surgery Secondary to Critical Stenoses of the Left Subclavian and Left Main Coronary Arteries


      We present a case of a 62-year-old man who was in cardiogenic shock. He had a history of coronary artery bypass grafting 4 years previously, with left internal mammary radial artery Y-grafting to a left dominant coronary circulation. Critical stenoses of the left main coronary and left subclavian arteries were seen at angiography. An occluded abdominal aorta precluded the use of mechanical circulatory support. The patient underwent high-risk stenting of the left subclavian artery with a successful outcome. The case highlights the unresolved issue of screening for subclavian stenoses in patients being considered for revascularization with arterial Y-grafting.


      Nous présentons le cas d’un homme de 62 ans en choc cardiogénique. Ce patient avait subi un pontage aortocoronarien 4 ans auparavant, par un montage en Y d’une artère thoracique et d’une artère radiale internes gauches pour une circulation coronaire gauche dominante. Une sténose critique de l’artère coronaire gauche principale et de l’artère subclavière gauche a été observée à l’angiographie. L’occlusion de l’aorte abdominale écartait le recours à l’assistance circulatoire mécanique. Le patient s’est soumis à l’installation très risquée d’une endoprothèse dans l’artère subclavière gauche, intervention qui s’est avérée une réussite. Ce cas met en évidence le problème non résolu du dépistage des sténoses subclavières lorsque la revascularisation par un montage en Y des artères est envisagée.
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