Coronary Steal Treatment- Cardiology

Coronary steal is the physiological or pharmacological vasodilation of the heart’s blood vessels and is synonymous to "stealing" of blood from another part of the heart with the use of a vasodilator. The narrowed heart arteries are dilated widely to compensate for the decrease in blood flow. As a result, blood is directed away from the ischemic parts of the heart, further leading to worsened ischemia.

Why is coronary steal treatment required?

Those with atherosclerotic occlusive plaques in the subclavian artery are generally asymptomatic and may require no treatment. However, if there is dizziness and arm pain, subclavian artery occlusion should be considered.

There is no exact treatment that can treat subclavian steal syndrome. However, if there is atherosclerotic stenosis or obstruction of the proximal subclavian artery, patients may be treated with antiplatelets to decrease the rirsk for heart attacks, stroke, and other vascular problems.

If there is retrograde vertebral artery blood flow, surgery or angioplasty or stenting may be done.

Which doctor to consult

Talk to a cardiologist, who will explain to you about the treatments, the risks and after-care.

What to expect during coronary steal treatment

Percutaneous intervention is viewed as the principal line of treatment if there is  subclavian steal disorder. These interventions include:

• Endovascular approach alongside percutaneous transluminal angiography (PTA)
• Peripheral stenting

These treatment approaches has many advantages, which include:

• A negligibly intrusive methodology
• Shorter length of hospital stay
• Less chances of illnesses
• Avoidance of general anaesthesia
• Fast recuperation

Surgical treatments may be considered to a less degree. It comprises of:

• Placement of a clip on the anastomotic channel or on the bypass of the channel with a vein graft in order to induce occlusion.
• ECA endarterectomy or angioplasty/ stenting is performed for ipsilateral transient ischemic attacks (either hemispheric or ocular) in patients with ipsilateral internal carotid artery occulsion and severe stenosis of the external carotid artery.

Revision using distal flow (RUDI) is performed if there is an occurrence of severe heart failure due to brachial AV access. This technique includes the conclusion of the anastomosis in the antecubital fossa and afterward intervening between the lower arm’s ulnar.

Proximalization of the Arterial Inflow (PAI) will help in improving the entry flow.

Distal revascularisation – interim ligation (DRIL) is a complex and tedious technique. It is generally conceivable when there is a viable blood vessel.

References

• Coronary Steal - an overview | ScienceDirect Topics. (2019). Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/coronary-steal
• Coronary Steal Syndrome — Definition and Symptoms | Medical Library. (2019). Retrieved from https://www.lecturio.com/magazine/coronary-steal-syndrome/#treatment-of-coronary-steal-syndrome

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