{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:02:28Z","timestamp":1777633348860,"version":"3.51.4"},"reference-count":5,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>ST-segment elevation in lead aVR typically signifies left main or triple-vessel disease. In post-coronary artery bypass grafting (CABG) patients, this pattern, alongside patent grafts, necessitates investigating alternative causes of myocardial ischemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 74-year-old male post-CABG presented with angina and ECG showing ST elevation in aVR with diffuse depression. Angiography revealed severe native coronary disease but patent grafts, including left internal mammary artery (LIMA) to left anterior descending artery. Persistent symptoms prompted further evaluation, which identified a critical left subclavian artery stenosis, compromising LIMA flow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case identifies left subclavian artery stenosis as a cause for aVR ST elevation in post-CABG patients by limiting LIMA graft inflow. It emphasizes the importance of evaluating extracoronary vascular lesions in recurrent ischemia despite patent grafts. Recognition and endovascular treatment of this condition can rapidly resolve symptoms and ECG abnormalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1782401","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T04:32:25Z","timestamp":1777437145000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A newly identified cause of ST-segment elevation in lead aVR"],"prefix":"10.3389","volume":"13","author":[{"given":"Wei","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cardiology, The 305 Hospital of People's Liberation Army of China","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The 305 Hospital of People's Liberation Army of China","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pan","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The 305 Hospital of People's Liberation Army of China","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chaoji","family":"Huangfu","sequence":"additional","affiliation":[{"name":"Beijing Institute of Radiation Medicine","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dayong","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The 305 Hospital of People's Liberation Army of China","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1001\/jamainternmed.2021.8532","article-title":"An unusual cause of ST-segment elevation in lead aVR","volume":"182","author":"Wang","year":"2022","journal-title":"JAMA Intern Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1016\/j.jaccas.2021.02.014","article-title":"Electrocardiographic recognition of unprotected left main ST-segment elevation myocardial infarction: looking beyond aVR","volume":"3","author":"Gonzalez-Bravo","year":"2021","journal-title":"JACC Case Rep"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e63","DOI":"10.1056\/NEJMicm2408911","article-title":"Coronary subclavian steal syndrome","volume":"391","author":"Chaudhari","year":"2024","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1007\/s12471-023-01772-5","article-title":"Coronary subclavian steal","volume":"32","author":"Olsthoorn","year":"2024","journal-title":"Neth Heart J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.tcm.2022.12.008","article-title":"Impact of coronary-subclavian steal after surgical myocardial revascularization with internal thoracic artery in chronic hemodialysis patients: a meta-analysis","volume":"34","author":"Baudo","year":"2024","journal-title":"Trends Cardiovasc Med"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1782401\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T04:32:49Z","timestamp":1777437169000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1782401\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":5,"alternative-id":["10.3389\/fcvm.2026.1782401"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1782401","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"article-number":"1782401"}}