Coronary steal: how many thieves are out there?

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.

Automated summary

The term "coronary steal" was coined in 1967, similar to the previously used term "subclavian steal" in 1961. "Steal" in both cases describes flow reversal in an abnormal vascular network, one involving subclavian stenosis and the other involving a coronary fistula. Over time, the term has expanded to include various pathophysiology that leads to a decrease in stress flow rather than explicit flow reversal. This review provides insights into the clinical and pathophysiological aspects of coronary steal, discussing the anatomical and physiological conditions that allow its occurrence and presenting treatment options for different scenarios.