[17] Abramson JL, Veledar E, Weintraub WS, Vaccarino V. Association between gender and in-hospital mortality after percutaneous coronary intervention according to age. Am J Cardiol 2003;91(8):968–71 A4. [18] Jacobs AK, Johnston JM, Haviland A, et al. Improved outcomes for women undergoing contemporary percutaneous coronary intervention: a report from the National Heart, Lung, and Blood Institute Dynamic registry. J Am Coll Cardiol 2002;39(10):1608–14. [19] Welty FK, Lewis SM, Kowalker W, Shubrooks Jr SJ. Reasons for higher in-hospital mortality N 24 hours after percutaneous transluminal coronary angioplasty in women compared with men. Am J Cardiol 2001;88(5):473–7. [20] Lima VC, Mattos LA, Caramori PR, et al. Expert consensus (SBC/ SBHCI) on the use of drug-eluting stents: recommendations of the Brazilian society of interventional cardiology/Brazilian society of cardiology for the Brazilian public single healthcare system. Arq Bras Cardiol 2006;87(4):e162–7. [21] Barlis P, Di Mario C. Still a future for the bare metal stent? Int J Cardiol 2007;121:1–3. 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.08.094 Prevalence and treatment of proximal left subclavian artery stenosis in patients referred for coronary artery bypass surgery Amit Prasad a , Anand Prasad b , Indu Varghese b , Michele Roesle b , Subhash Banerjee b , Emmanouil S. Brilakis b, ⁎ a Department of Internal Medicine, University of Texas Southwestern Medical School, United States b Division of Cardiovascular Diseases, University of Texas Southwestern Medical School and Department of Cardiology Dallas VA Medical Center, Dallas, Texas, United States Received 27 July 2007; accepted 10 August 2007 Available online 26 December 2007 Abstract The left internal mammary artery (LIMA) is currently used in most coronary artery bypass graft (CABG) surgeries due to excellent long- term patency. Left subclavian artery stenosis (SAS) proximal to the LIMA origin can cause a steal syndrome leading to myocardial ischemia or LIMA failure. We retrospectively evaluated the records of 608 consecutive patients referred for CABG at our institution between October 1, 2004 and October 1, 2006 and identified 226 patients (37%) who underwent left subclavian angiography immediately after diagnostic coronary angiography. Significant left SAS was found in 6 of those 226 patients (2.7%). Subclavian angiography did not result in any complications. All left SAS lesions were successfully stented, followed by CABG surgery (using the LIMA artery) after 22 ± 7 days. Left subclavian angiography in patients referred for coronary artery bypass surgery has low risk and may identify a small proportion of patients with significant proximal left SAS. Stenting of proximal left SAS can be accomplished before CABG with low risk and excellent short- term outcomes. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Subclavian artery stenosis; Coronary subclavian steal syndrome; Coronary artery bypass surgery ⁎ Corresponding author. Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, TX 75216, United States. Tel.: +1 214 857 1547; fax: +1 214 302 1341. E-mail address: emmanouil.brilakis@utsouthwestern.edu (E.S. Brilakis). The left internal mammary artery (LIMA) is currently used in almost all coronary artery bypass graft (CABG) surgeries. Left subclavian artery stenosis (SAS) proximal to the LIMA origin could obstruct the LIMA blood flow and lead to myocardial ischemia and LIMA failure [1,2]. Although subclavian angiography can aid in diagnosis and treatment of proximal SAS [1] it has not gained widespread acceptance in part because it carries some risk [3,4]. Percutaneous SAS treatment may have high restenosis rates [5,6], and surgical intervention has been proposed as a more durable option [7,8]. We retrospectively reviewed the medical records and coronary angiograms of 608 consecutive patients referred for 109 Letters to the Editor