Diagnosis and targeted percutaneous management of a critical subclavian artery stenosis in a patient with absent peripheral pulses with the use of cardiac computed tomography

Abstract 

Current clinical practice dictates that invasive management strategies frequently are adopted in patients with both ST-segment elevation and non–ST-segment elevation acute coronary syndromes. Such strategies rely on obtaining vascular access and, as such, are not always technically feasible. We report a case in which cardiac computed tomography was used to great effect in the diagnostic and (targeted) interventional management of a patient who was the recipient of a previous coronary artery bypass grafting and presented with global myocardial ischemia, in whom the lack of peripheral pulses had previously rendered an early invasive strategy hazardous.

Keywords: Acute coronary syndrome, Cardiac computed tomography, Coronary artery bypass graft patency, Coronary-subclavian steal syndrome, Subclavian artery stenosis