Subclavian artery stenting as a method of endovascular reduction of competitive blood flow in mammarocoronary shunt in the treatment of acute coronary syndrome without ST segment elevation

Rationale: currently, the problem of mammarocoronary shunt dysfunction remains urgent, one of the most frequent causes of which is the occurrence of competitive blood flow, which leads to shunt occlusion. Purpose and methods: in the presented work, using the example of a clinical case, the cause of competitive blood flow in a mammarocoronary shunt is shown, which ultimately led to the emergence of acute coronary syndrome without ST segment elevation, as well as the logic of deciding on the volume of revascularization and the result of the use of endovascular methods to reduce competitive blood flow. Conclusion: in the interventional treatment of acute coronary syndrome in patients after coronary artery bypass grafting, it is necessary to assess the blood flow rate in the shunts, perform not only shuntography, but also angiography of the subclavian arteries if mammarocoronary shunts were formed, and also when planning and performing endovascular treatment, it is necessary to take into account possible causes of competitive blood flow not only before but also after it.