Coronary steal: how many thieves are out there?

Eur Heart J. 2023 Aug 7;44(30):2805-2814. doi: 10.1093/eurheartj/ehad327.

Abstract

The colorful term "coronary steal" arose in 1967 to parallel "subclavian steal" coined in an anonymous 1961 editorial. In both instances, the word "steal" described flow reversal in the setting of an interconnected but abnormal vascular network-in one case a left subclavian stenosis proximal to the origin of the vertebral artery and in the other case a coronary fistula. Over time, the term has morphed to include a larger set of pathophysiology without explicit flow reversal but rather with a decrease in stress flow due to other mechanisms. This review aims to shed light on this phenomenon from a clinical and a pathophysiological perspective, detailing the anatomical and physiological conditions that allow so-called steal to appear and offering treatment options for six distinct scenarios.

Trial registration: ClinicalTrials.gov NCT02184117 NCT02328820 NCT04789317.

Keywords: ALCAPA syndrome; CTO collaterals; Collateral circulation; Coronary fistulae; Coronary steal; LIMA branch; Subclavian steal syndrome; Tumor steal.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Coronary Artery Disease*
  • Coronary-Subclavian Steal Syndrome*
  • Heart
  • Humans
  • Subclavian Steal Syndrome*
  • Vertebral Artery

Associated data

  • ClinicalTrials.gov/NCT02184117
  • ClinicalTrials.gov/NCT02328820
  • ClinicalTrials.gov/NCT04789317