Subclavian artery stenosis and blood pressure control

Critical Left Subclavian Artery Stenosis With Retrograde Vertebral Flow: A Case Report and Literature Review

Subclavian artery stenosis is a rare condition associated with significant morbidity and mortality, making prompt recognition and treatment essential. We present a case of left-sided subclavian artery occlusion with neurological symptoms, including vertigo, unsteady gait, and left upper extremity pain and paresthesia. The patient's symptoms had been progressing over several months. Her risk factors included age, hyperlipidemia, and poorly controlled blood pressure with resultant arteriosclerosis throughout her vasculature. An arteriogram demonstrated critical stenosis of the left subclavian with retrograde flow through the left vertebral artery. Aspirin and clopidogrel were initiated prior to successful balloon angioplasty and stenting. After stent placement, the patient had minimal residual subclavian stenosis and anterograde vertebral artery flow. In this case report, we discuss clinical presentation, typical examination and imaging findings, and treatment options for subclavian stenosis including medical management and revascularization procedures.

Local Hemodynamic Changes Immediately after Correction of an Aberrant Right Subclavian Artery in a Dog: A Contrast Computed Tomographic Study

A 1-year-old female Akita dog was referred for intermittent regurgitation. Computed tomographic angiography (CTA) showed an aberrant right subclavian artery (ARSA), resulting in constriction of the esophagus. After surgical ligation of the ARSA, CTA showed that the ARSA was not enhanced by contrast medium, and that sufficient collateral circulation of the right forelimb was supplied through the vertebral artery. Furthermore, the right and left vertebral arteries merged into the basilar artery at the level of the atlas, and no abnormal expansion of the ventral spinal artery was observed. Overall, we demonstrated the importance of post-surgical CTA for identification of surgical complications, including the formation of abnormal vessel alterations.

Computed tomography angiography reveals stenosis and aneurysmal dilation of an aberrant right subclavian artery causing systemic blood pressure misreading in an old Pekinese dog

A 14-year-old dog weighing 4 kg presented with hypotension only in the right forelimb. Thoracic radiography revealed a round soft tissue opacity near the aortic arch and below the second thoracic vertebra on a lateral view. Three-dimensional computed tomography angiography clearly revealed stenosis and aneurysmal dilation of an aberrant right subclavian artery. Stenosis and aneurysm of an aberrant subclavian artery should be included as a differential diagnosis in dogs showing a round soft tissue opacity near the aortic arch and below the thoracic vertebra on the lateral thoracic radiograph.