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타카야수 혈관염 환자에서 발생한 관상동맥-쇄골하동맥 도류증후군
김민선 ( Min Sun Kim ),백남영 ( Nam Young Paik ),최승혁 ( Seung Hyuk Choi ),김욱성 ( Wook Sung Kim ),김성목 ( Sung Mok Kim ),전평 ( Pyoung Jeon ),김덕경 ( Duk-kyung Kim ) 대한내과학회 2016 대한내과학회지 Vol.91 No.1
A 37-year-old woman who had undergone coronary artery bypass grafting (CABG) surgery for left main and right coronary ostial lesions 2 years prior presented with angina and transient visual dimness. Computed tomography angiography showed a patent left internal mammary artery (LIMA) bypass graft and concentric narrowing with perivascular thickening around the arch vessels. The patient was diagnosed with Takayasu arteritis with coronary subclavian steal syndrome (CSSS). Thoracic angiography revealed severe stenosis of the left proximal subclavian artery (SCA) and reverse flow from the coronary artery to the distal left SCA via the LIMA graft. Successful percutaneous stenting of the left SCA was performed together with stenting of the right common carotid artery (CCA). The patient’s symptoms were completely resolved. This case is informative since it shows that Takayasu arteritis can manifest as angina due to coronary ostial lesions and then can involve arch vessels, which can lead to CSSS in patients with CABG. (Korean J Med 2016;91:37-41)