Abstract
To the Editors:
I read with great interest the study by Song et al. 1 regarding endovascular stenting vs. extrathoracic surgical bypass for symptomatic subclavian steal syndrome. The authors should be congratulated on perhaps one of the largest, if not the largest, comparison between surgical and endovascular techniques. The data provide the vascular specialist with 10-year outcomes of both procedures. Based on my ongoing interest in subclavian artery disease, as well as the coronary-subclavian steal syndrome,2–4 what is very intriguing are the long-term patency rates. It seems that although the endovascular route is certainly less invasive, and reinterventions for restenosis are simpler for the patient and operator, long-term patency is less than with open surgical repair. Perhaps with this knowledge, the consultant should recommend subclavian bypass procedures when faced with the possibility of coronary-subclavian steal prior to coronary artery bypass grafting (CABG) with the left internal mammary artery (LIMA) conduit. If the stenosis is discovered preoperatively, bypass may be optimal; if it is discovered after the bypass operation, however, the endovascular route is perhaps the must judicious approach due to the lower morbidity and physiological stress and shorter coronary ischemic time. I would be interested in learning the approach that Dr. Song and his colleagues take when faced with coronary subclavian steal syndrome both before and after CABG with the LIMA graft.