Multimodality imaging of coronary-subclavian-vertebral steal syndrome.

A 59-year-old man was admitted with unresolved chest pain after coronary artery bypass graft surgery that had been performed 3 years earlier; aorta-obtuse marginalis, and aorta-posterior descending artery with the use of a saphenous vein graft and left anterior descending artery-left internal mammary artery (LIMA). He reported recurrent angina pectoris and cerebral symptoms, including dizziness and drop attacks, especially when moving his left arm. When he stopped moving his left upper extremity, these symptoms were spontaneously resolved within minutes. On physical examination, pulse rate was regular at 72 beats/min, and there was a significant blood pressure difference between the right and the left arm (135/85 mm Hg and 95/65 mm Hg, respectively). On auscultation, there was a marked bruit at the left supraclavicular region. The results of transthoracic echocardiography were within normal limits. We performed coronary computed tomography angiography to display the cause of ischemic symptoms. Coronary computed tomography angiography revealed that the left subclavian artery was totally occluded 2 cm from its …