Angioplasty Using Kissing Balloon Technique for Left Subclavian Artery Stenosis Concomitant with Origin of Vertebral Artery Stenosis Following Coronary Artery Bypass Using Internal Thoracic Artery: A Case Report

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Objective: Subclavian artery (SA) stenoses are typically asymptomatic because of well-developed collateral circulation. In patients who have undergone coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA), SA stenosis can induce coronary–subclavian steal syndrome and cause myocardial ischemia. Therefore, immediate interventions are required for such a dangerous condition. Furthermore, SA stenosis involving the origin of the vertebral artery (VA) requires simultaneous protection of the origin of the VA due to the risk of acute occlusion during the balloon angioplasty of the SA. We report a successful treatment of SA stenosis involving the origin of the VA following CABG using ITA, adopting the kissing balloon technique.

Case Presentation: A 68-year-old man with a history of CABG using the left ITA for acute myocardial infarction developed severe left SA stenosis extending to the origin of the dominant left VA. Percutaneous transluminal angioplasty and stenting using the kissing balloon technique were performed to avoid the occlusion of the origin of the VA. Successful dilatation of the SA was achieved with good patency of the VA and the ITA. Postoperative imaging confirmed improved perfusion of the ITA bypass and the VA. The patient tolerated the procedures well without any neurological deficits, and follow-up 3D CTA obtained 3 months after the procedure demonstrated good patency of the SA, ITA, and VA.

Conclusion: This case highlights the safety and effectiveness of the kissing balloon technique in the treatment of complex SA stenosis involving the origin of the VA following CABG using the ITA. The kissing balloon technique enables simultaneous dilation of SA lesions and protection of the VA.