UMEM Educational Pearls

Coronary Subclavian Steal Syndrome

Coronary subclavian steal syndrome (CSSS) is defined as coronary ischemia resulting from the reversal of flow in an internal mammary arterial graft usually secondary to subclavian stenosis.

Angiographic subclavian stenosis is defined as greater than 50% narrowing or greater than 20mmHg pressure difference across a lesion.

CSSS occurs in up to 4.5% of patients with prior CABG & common in older individuals with existing peripheral vascular disease.

CSSS most commonly manifests as stable angina, but frequently presents as unstable angina, acute myocardial infarction, acute systolic heart failure or even cardiogenic shock.

Screening for subclavian stenosis prior to CABG w/bilateral noninvasive blood pressure assessment, and a 15 mmHg or greater discordance should elicit further imaging.

Percutaneous revascularization is the first-line therapy for CSSS and has excellent long-term outcomes. 


Sintek M, Coverstone E, Singh J. Coronary Sunclavian Steal Syndrome. Current Opinion in Cardiology. Issue: Volume 29(6) pgs. 506-513 November 2014.