Use of a cutting balloon and a paclitaxel-coated balloon to treat recurrent subclavian in-stent restenosis causing coronary subclavian steal syndrome

A 56-year-old male with a past history of coronary artery bypass graft surgery underwent stent implantation for a severe proximal left subclavian artery stenosis. Recurrent in-stent restenosis (ISR) resulted in the coronary subclavian steal syndrome (CSSS), with angina due to compromised blood flow in the left internal mammary artery/radial composite bypass graft. This was treated with cutting balloon predilatation followed by paclitaxel-coated balloon (PCB) dilatation, with an excellent angiographic result. At 10 months of follow-up, blood pressure in both arms was equal, and the patient remained symptom free. To our knowledge, this is the first report of successful treatment of subclavian ISR causing CSSS with a PCB.