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Have you or someone you know had a similar experience?
My father 57, a diabetic, has sleep apnea, and A-fib. He also has a pacemaker, has had a prior heart attack and stents. Most recently, in January 2022 my father had a N-Stemi heart attack. Five days later he had a quad bypass graph. For two months he was doing physical therapy and checking in with his cardiologist as recommend. In late March he had an atrial event and was hospitalized. He then had a stress test which came back abnormal and a subsequent heart cath. There was then an attempt to stent his subclavian, which failed. He now has diagonal graft stenosis or oucclusion, subclavian steal syndrome and angina. His doctors implied that this was an uncommon situation. They changed his medication from Warfarin to Eliquis. Increased dosage of Metoprolol to 100 mg. They also added Imdur 30 mg and Crestor 10 mg and set up a 4 week follow up appointment. I am wondering if anyone has had any similar experiences? Thank you for taking the time to read this.
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Hello @daisubuckley and welcome to Mayo Clinic Connect. Your father has certainly been through quite a lot.
I found this comment from member @jenniferhunter on the topic of Subclavian Steal Syndrome that you may find of interest:
https://connect.mayoclinic.org/discussion/severe-spinal-stenosis/?pg=2#comment-290287
Jennifer may be able to come in share more with you after reading your father's situation, although her initial response was related to spinal stenosis.
Is your father experiencing any positive changes following the change in medications?
@daisubuckley Thank you Amanda for inviting me into this discussion. @daisubuckley, am I correct from reading your description that It sounds like the failed stent caused the occlusion in the Subclavian artery which then generated the Subclavian Steal Syndrome which actually reverses the arterial blood flow away from the brain? If that is correct, is there any correction possible for this? Can the stent be removed? I don't have knowledge of what can be done with stents, and was just wondering if there could be a resolution.
I'm wondering if a consult with a vascular thoracic surgeon could shed any light on a possible resolution? When I was at Mayo for cervical spine surgery, I also had a consult with a thoracic surgeon about my thoracic outlet syndrome (TOS), and some surgical treatments for TOS involves removing a first rib or scalene muscle in the area near the subclavian artery and vein. Did the cardiologist suggest a surgical consult about the occlusion? Of course that is a surgery that carries risks, and my doctors have not recommended surgery for my TOS because it can make it worse from scar tissue. TOS can be common, and if he also has TOS (which gets missed often) that could change what is recommended by doctors.
This link explains issues with vestibular impairment and has the quote in the other discussion that Amanda mentioned about Subclaviam Steal Syndrome.
https://mskneurology.com/vestibular-impairment-and-its-association-to-the-neck-and-tmj/
I searched and found a link to literature with some surgical cases of Subclavian Steal Syndrome. Some of the treatment talks about doing a bypass involving the Carotid artery, and this study mentions possible clot formation because of stents and use of anti-clotting medications. It also mentions the need for controlling sugar and diet in diabetics, etc. Having heart disease in combination with another condition where oxygenated blood is directed away from the brain could confuse things in the future on what is causing symptoms between if it the abnormal circulation, or the heart not doing its job in sending blood out to the body. It is worth asking how that may interfere with future diagnosis. It seems often stents are placed to fix Subclavian Steal Syndrome when it is caused by something else like plaque formation in the artery.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4984364/
"Subclavian steal: Endovascular treatment of total occlusions of the subclavian artery using a retrograde transradial subintimal approach"
Is your father being seen at a multidisciplinary medical center where he could also have a consult with a thoracic surgeon? Are you considering getting a second opinion at another medical center that has no connection to his current doctors?
I your father was interested in seeking treatment at any of the Mayo Clinic campuses, this link will get you started in seeking an appointment.
http://mayocl.in/1mtmR63