Diagnostic Pitfalls in Atypical Coronary-subclavian Steal Syndrome

We present a case of a 63-year-old patient with crescendo angina 12 years after coronary artery bypass graft surgery. Angiography demonstrated coronary-subclavian steal caused by severe left subclavian artery stenosis with collateral flow from an anomalous left vertebral artery, arising from the aorta. We discuss the unique angiographic features of this atypical case of coronary-subclavian steal syndrome along with its treatment.