Coronary subclavian steal syndrome in the emergency department - A case report
When evaluating a patient with chest symptoms and a history suggestive of prior CABG, especially involving the left subclavian artery, don't overlook CSSS. Prompt ordering of a CT Angiogram or Aortogram is key to visualizing the steal phenomenon, and early activation of Vascular Surgery should be standard practice for definitive management.
This case report highlights Coronary Subclavian Steal Syndrome (CSSS), a relatively uncommon but clinically significant issue that can manifest following coronary artery bypass grafting, particularly when LIMA-LAD grafting is performed alongside left subclavian stenosis. The authors emphasize that even when initial workups for chest pain or NSTEMI are inconclusive, the constellation of risk factors warrants consideration of CSSS. They argue that emergency physicians need to keep this diagnosis high on their differential list in appropriate patients. The core recommendation revolves around timely advanced imaging and specialist consultation.