A patient who suffered recurrent myocardial ischaemia and cerebrovascular symptoms 56 months after a quadruple coronary bypass is reported. Three coronary arteries had been bypassed using reversed saphenous vein and the other using the left internal mammary artery (IMA). Coronary angiography demonstrated patency of all bypasses but the presence of an obstruction of the left subclavian artery proximal to the origin of the left IMA, with angiographic criteria of the steal syndrome. The patient's symptoms were relieved by bypass from the left common carotid artery to the distal left subclavian artery. The pathophysiology, diagnosis, prevention and treatment of coronary steal syndrome are discussed.
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