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Ahn MH, Ku BD, Kim MK. Successful subclavian artery stenting in a patient with subclavian steal syndrome associated with contralateral vertebral artery hypoplasia. J Postgrad Med 2023; 69:245-246. [PMID: 37675663 PMCID: PMC10846804 DOI: 10.4103/jpgm.jpgm_44_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- MH Ahn
- Department of Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - BD Ku
- Department of Neurology, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - MK Kim
- Department of Cardiology, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea. E-mail:
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Salihefendic N, Zildzic M, Huseinagic H. Subclavian Steal Syndrome Caused by Thrombosis Associated with COVID-19: a Case Report. Med Arch 2022; 76:473-475. [PMID: 36937614 PMCID: PMC10019878 DOI: 10.5455/medarh.2022.76.473-475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/15/2022] [Indexed: 12/26/2022] Open
Abstract
Background Thromboembolic complications are a frequent occurrence during COVID-19. This report presents a patient with signs of subclavian steal syndrome (SSS) caused by a thrombus in the initial part of the right subclavian artery. Pathological occlusive changes, such as thrombosis, are four times more common on the left subclavian. Thrombosis of the subclavian artery occurs in about 1% of the population, but atherosclerotic changes are common and usually asymptomatic. Objective The aim of this report is to present a patient with signs of subclavian steal syndrome (SSS) caused by a thrombus in the initial part of the right subclavian artery associated with symptoms of COVID-19. Case report A 56-year-old female patient presented with tremor, numbness and prickling in the right hand, tinnitus, blurred vision, vertigo, syncope, trismus and headaches. The formation of a thrombus caused neurological symptoms in the right hand with a stronger pronounced tremor, headache and syncopal episodes. Routine CT with angiography did not reveal significant subocclusions of the neck arteries or significant ischemic changes in the brain. The patient was treated as Parkinsonismus (disease) with syncopal and collapsing episodes. Due to worsening subjective complaints, CT angiography of the neck and head blood vessels was repeated with iterative 3D reconstruction. The examination, as mentioned above, revealed atherosclerotic changes with thrombosis and stronger subocclusion of the right subclavian artery (RSA) proximal to the origin of the arteria vertebralis. Both vertebral arteries, as well as arteria basilaris, had a normal appearance. During physical exertion of the right arm doppler examination of neck blood vessels revealed the presence of reverse blood flow in the right vertebral artery. Haematological tests and high D-dimer also confirmed the diagnosis. After anticoagulant therapy, the thrombotic mass on the mural calcified RSA plaque disappeared. With the reduced physical strain on the right hand and a lifestyle change, syncopal conditions and headaches stopped. There was a reduction in tremors and tingling in the right hand as well. Conclusion We reported a case of subclavian steal syndrome caused by thrombosis associated with OVID-19. Thromboembolic complications are common in the course of this disease. The diagnosis was confirmed with advanced diagnostic tools (CTA with 3D reconstruction), laboratory tests (D-dimer) and doppler ultrasound. When routine CT angiography is not completely clear, 3D reconstruction is necessary.
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Affiliation(s)
| | - Muharem Zildzic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
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Suma S, Coli S, Palumbo A, Graziuso S, Borrello B, Gaibazzi N. Vertebral Doppler Bunny Waveform Suggesting Subclavian Stenosis and Influencing Coronary Artery Bypass Technique. Tex Heart Inst J 2020; 47:70-71. [PMID: 32148464 DOI: 10.14503/thij-17-6406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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梁 毅, 丘 丽, 谢 静. [Subclavian artery stenosis combined with vertebral artery stenosis may lead to compensatory blood flow changes in the contralateral vertebral artery]. Nan Fang Yi Ke Da Xue Xue Bao 2018; 38:1509-1513. [PMID: 30613022 PMCID: PMC6744209 DOI: 10.12122/j.issn.1673-4254.2018.12.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the severity of blood steal and the hemodynamic profiles in patients with subclavian artery stenosis combined with vertebral artery stenosis. METHODS A retrospective analysis was performed of transcranial Doppler (TCD) data from patients with subclavian artery stenosis (SAS) and concomitant unilateral/bilateral vertebral artery stenosis (VAS, >50%) or occlusion in our institution between February, 2014 and July, 2018.Thirty-seven patients with SAS combined with VAS (SAS+VAS) were reviewed for types of blood steal, peak systolic velocities of blood flow in affected subclavian artery and the contralateral vertebral artery, and the findings of hyperemia testing.These data were also reviewed for 39 SAS patients without VAS (control group) for comparison of blood steal and hemodynamic profiles. RESULTS In SAS+VAS group, 5 patients showed no blood steal; blood steal in stage Ⅰ was found in 22 patients, stage Ⅱ in 7, and stage Ⅲ in 3, as compared to the numbers of 17, 12 and 10 in the control group, respectively (H=9.431, P=0.002).The peak systolic velocity of the contralateral vertebral artery was 43.91±17.43 cm/s in SAS+VAS group, significantly lower than that in the control group (53.56±17.45 cm/s; t= 629.5, P=0.006).Hyperemia testing showed a significant difference in the negative rate between SAS+VAS group and the control group[35.1%(13/37) vs 7.7%(3/39);χ2=8.603, P=0.003). CONCLUSIONS SAS combined with VAS may lead to reduced compensatory blood flow in the contralateral vertebral artery to lessen the severity of subclavian steal syndrome.
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Affiliation(s)
- 毅仪 梁
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
| | - 丽雅 丘
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
| | - 静芳 谢
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
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Wettstein RKRW, van der Kallen BFW, Moojen WA, Tewarie RN. Thoracic epidural haematoma due to a subclavian steal syndrome and secondary formed thoracic collateral circuits, coincidence or consequence: a case report. Acta Neurochir (Wien) 2018; 160:205-208. [PMID: 29167977 DOI: 10.1007/s00701-017-3402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/13/2017] [Indexed: 11/26/2022]
Abstract
Despite profound diagnostics, the aetiology of spinal epidural haematoma (SEH) often remains unknown. In this case, diagnostics revealed an SEH at the fifth and sixth thoracic levels due to a subclavian steal syndrome with a tortuous vascular loop between the sixth thoracic intercostal artery and the costocervical arteries deriving from the left subclavian artery with plump arteries in the epidural space. The patient underwent decompression surgery and a percutaneous transluminal angioplasty. The patient showed good recovery at follow-up. The SEH was a result of secondary formed thoracic collateral circuits with epidural involvement due to a subclavian steal syndrome.
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Affiliation(s)
- Ravian K R W Wettstein
- Department of Neurosurgery, Haaglanden Medical Centre, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
| | | | - Wouter A Moojen
- Department of Neurosurgery, Haaglanden Medical Centre, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rishi Nandoe Tewarie
- Department of Neurosurgery, Haaglanden Medical Centre, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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Komenaka IK, Nguyen ET, Oyogoa SO, DeGraft-Johnson JB, Gardezi SQ. Subclavian Steal Syndrome in Acute Myocardial Infarction Masquerading as Acute Embolism to Left Upper Extremity. Angiology 2016; 55:209-12. [PMID: 15026877 DOI: 10.1177/000331970405500214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subclavian steal syndrome is an uncommon entity diagnosed with angiography after neurologic symptoms occur during activity with the upper extremity. Cardiac symptoms or silent ischemia have been described in patients who have undergone cardiac bypass using the ipsilateral internal mammary artery. Our patient presented with acute chest pain radiating to the left upper extremity and a diminished pulse. Angiography to rule out an acute embolus instead revealed subclavian artery occlusion. As atherosclerosis is the most common cause, the ipsilateral subclavian artery should be carefully evaluated, particularly in cardiac patients undergoing coronary angiography. Recognition of coexisting subclavian artery occlusion could prevent cardiac complications that may occur with use of the ipsilateral internal mammary artery during coronary artery bypass surgery.
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Abstract
Due to the increased use of internal mammary artery grafts for coronary revascularization, proximal subclavian stenosis resulting in coronary-subclavian steal has become an important clinical entity. Patients present with varying signs and symptoms of recurrent myocardial ischemia that not only can limit lifestyle but also be life-threatening. A careful history and physical examination with the identification of risk factors such as peripheral vascular disease and arm blood pressure differential >20 mm Hg can identify patents at high risk for developing this syndrome. Identifying these patients before coronary artery bypass grafting can prevent this important problem by altering the therapeutic approach to coronary revascularization. When patients present after coronary artery bypass grafting with coronary-subclavian steal, therapeutic options of percutaneous transluminal angioplasty and stent placement to the subclavian artery, carotid-subclavian bypass, and axillary-axillary bypass all have high success rates with excellent long-term patency rates. The choice for the type of revascularization needs to be individualized based on the lesion morphology and clinical comorbidities. Three patients who presented with signs and symptoms of myocardial ischemia due to coronary subclavian steal are presented. All 3 patients had incapacitating symptoms, and all 3 were treated successfully with different revascularization techniques due to other medical conditions or comorbidities.
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Affiliation(s)
- Steven M Costa
- Texas A&M University System Health Science Center, Scott and White Hospital, Division of Cardiology, Temple, TX 76508, USA.
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Tong XG, Wang Y, Chen Y, Zhang C, Li CH, Dong Z, Zhang XW, Zhang FF, Yin H, Wang JH, Zhang PL. Intravenous Thrombolytic Therapy for Acute Ischemic Stroke with Subclavian Arterial Steal Syndrome: A Case Report. Cell Biochem Biophys 2015; 73:107-9. [PMID: 25697749 DOI: 10.1007/s12013-015-0559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Xiao-Guang Tong
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China
| | - Yuxin Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China
| | - Yan Chen
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China
| | - Chenhao Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China
| | - Chen-Hua Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China
| | - Zhong Dong
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China
| | - Xiao-Wei Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China
| | - Fang-Fang Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China
| | - Hang Yin
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China
| | - Jin-Huan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China
| | - Pei-Lan Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin, 300060, China.
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Affiliation(s)
- Cağdaş Unlü
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, Netherlands.
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Affiliation(s)
- Samantha Conlin
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Stephen J Fenning
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Graeme Weir
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Zahid Raza
- Department of Vascular Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Richard G Phelps
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Fiona J Gifford
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Gómez-Choco M, García S, León L. Peduncular hallucinosis in a patient with subclavian steal syndrome: usefulness of Doppler ultrasonography. J Clin Ultrasound 2014; 42:63-66. [PMID: 23553176 DOI: 10.1002/jcu.22042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/09/2012] [Accepted: 02/04/2013] [Indexed: 06/02/2023]
Abstract
The subclavian steal syndrome is characterized by retrograde flow within a vertebral artery ipsilateral to proximal subclavian artery high-grade stenosis or occlusion. It can cause vertebrobasilar insufficiency and hence diverse brainstem symptoms. Peduncular hallucinosis consists of visual images of brief duration that are related to thalamic or rostral brainstem lesions. We describe a patient with peduncular hallucinosis in the setting of subclavian steal syndrome. Inducing a hemodynamic challenge to the vertebrobasilar circulation elicited the patient́s visual symptoms. Thus, careful ultrasonographic evaluation with dynamic testing contributed to explain the physiopathology of the clinical symptoms.
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Affiliation(s)
- Manuel Gómez-Choco
- Neurology Department, Hospital Moises Broggi, Sant Joan Despí, Barcelona, Spain
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Osterne EMC, Osterne ECV, Motta VP, da Motta PAM, Salame CK, Osterne TEC. Percutaneous treatment of refractory angina secondary to left subclavian artery stenosis in patients after coronary artery bypass grafting. Arq Bras Cardiol 2013; 101:e58-60. [PMID: 24061759 PMCID: PMC4032314 DOI: 10.5935/abc.20130171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Vicente Paulo Motta
- Hospital Anchieta - Instituto do Coração de Taguatinga, São Paulo, SP -
Brazil
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Tanaka A, Sakakibara M, Okada K, Jinno Y, Ishii H, Murohara T. Coronary subclavian steal from a left internal thoracic artery coronary bypass graft due to ipsilateral subclavian artery stenosis and an arteriovenous graft in a hemodialysis patient with left vertebral artery occlusion. Intern Med 2013; 52:1195-8. [PMID: 23728554 DOI: 10.2169/internalmedicine.52.8950] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Coronary subclavian steal syndrome is an unusual cause of myocardial ischemia, secondary to a reversed blood flow in patients with patent internal thoracic artery coronary bypass grafts. The causes of coronary subclavian steal are either ipsilateral subclavian artery stenosis or upper extremity arteriovenous hemodialysis fistula formation or both. This report involves a 68-year-old woman with left vertebral artery occlusion who developed severe coronary steal in the absence of vertebral subclavian steal due to left subclavian artery stenosis and an arteriovenous hemodialysis graft.
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Correia M, Mendes S, Araújo C, Martins L, Bettencourt N, Leite D, Rocha J, Carvalho M. Subclavian steal syndrome in a coronary patient. Rev Port Cardiol 2011; 30:633-635. [PMID: 21874929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Miguel Correia
- Serviço de Cardiologia, Centro Hospitalar de Entre Douro e Vouga EPE, Santa Maria da Feira, Portugal.
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Arazińska A, Kręcki R, Kasprzak JD. [Coronary steal syndrome in a patient with ST-elevation myocardial infarction one year after coronary bypass grafting]. Kardiol Pol 2011; 69:1087-1090. [PMID: 22006617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Some patients after coronary artery bypass grafting (CABG) in long term follow-up need consecutive reinterventions due to progression of atherosclerotic changes or degeneration of venous bypass grafts. A rare cause of the recurrence of angina after CABG operation is coronary artery steal syndrome. We demonstrate a case report of a 66 year-old man after CABG procedure with a condition of acute myocardial infarction induced by steal syndrome of the side branch of left internal mammary artery.
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Affiliation(s)
- Agata Arazińska
- II Katedra i Klinika Kardiologii, Uniwersytet Medyczny w Łodzi, Łódź
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Salenius JP, Uurto I. [Subclavian steal syndrome]. Duodecim 2011; 127:2148-2154. [PMID: 22191201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Subclavian steal syndrome is a circulatory disorder usually caused by atherosclerosis and accompanied by ischemic symptoms of the vertebrobasilar region and the hand. In many cases, significant vascular lesions are found also in other arteries. In more than 80% of cases the blood vessel lesion is on the left, and a significant stenosis or occlusion causes an inter-arm pressure gradient of > 20 mmHg, resulting in retrograde blood flow of the ipsilateral vertebral artery. In local stenosis, conservative treatment can be combined with an intravascular procedure, and in occlusions or other arterial lesions requiring operative treatment, with bypass surgery.
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Sharma VK, Chuah B, Teoh HL, Chan BPL, Sinha AK, Robless PA. Chronic brainstem ischemia in subclavian steal syndrome. J Clin Neurosci 2010; 17:1339-41. [PMID: 20620065 DOI: 10.1016/j.jocn.2010.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 03/02/2010] [Accepted: 03/07/2010] [Indexed: 11/19/2022]
Abstract
Subclavian steal syndrome is usually an incidental finding and rarely causes vertebrobasilar ischemia. We present a 58-year-old man who, over six months, experienced progressive slowing in both talking and walking. Cervical duplex sonography revealed severe stenosis of the right subclavian artery; fixed retrograde flow was noted in the right vertebral artery on transcranial Doppler. The hyperemia-ischemia cuff test resulted in considerable reduction in flow velocities in both posterior cerebral arteries. We attributed his slowness to chronic vertebrobasilar ischemia and surgical revascularization was performed. His symptoms subsided immediately after surgery. The improved perfusion in the posterior circulation was demonstrated on technetium-99 hexamethylpropyleneamine oxime single photon-emission CT. Early diagnosis and prompt treatment resulted in an improved quality of life.
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Affiliation(s)
- Vijay K Sharma
- Division of Neurology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
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Edwin F, Mamorare HM. Congenital pulmonary steal in subclavian artery isolation. Ann Thorac Surg 2010; 90:1744-5; author reply 1745. [PMID: 20971318 DOI: 10.1016/j.athoracsur.2010.04.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 02/25/2010] [Accepted: 04/02/2010] [Indexed: 11/16/2022]
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Affiliation(s)
- Vishal Khurana
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Jones MB, Wadgaonkar S, Yount RD, Glancy DL. Stenting of the proximal left subclavian artery with relief of coronary-subclavian steal syndrome. J La State Med Soc 2009; 161:107-110. [PMID: 19489392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Michael B Jones
- Department of Medicine, Louisiana State University Health Sciences Center and Touro Infirmary, New Orleans, USA
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Henry M, Henry I, Polydorou A, Polydorou A, Hugel M. Percutaneous transluminal angioplasty of the subclavian arteries. INT ANGIOL 2007; 26:324-340. [PMID: 18091700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM The aim of this study was to review the feasibility, safety and long-term results of subclavian artery (SA) angioplasty. METHODS Over 14 years, 237 patients (males: 135; mean age: 64+/-12 years) underwent percutaneous treatment for SA occlusive disease. Indications for treatment were upper limb ischemia (n=125), vertebrobasilar insufficiency (n=128), coronary steal (n=11) and anticipated coronary bypass surgery in asymptomatic patients (n=26). A total of 192 arteries were stenosed and 45 occluded. Mean percentage stenosis was 81.9+/-7.6% and mean lesion length was 23.8+/-8.8 mm. Percutaneous techniques included retrograde femoral (n=163), brachial artery (n=47) access or both (n=14) and in 4 cases the ''pull through technique''. An isolated balloon angioplasty was performed in 59 cases. We implanted 132 balloon expandable stents and 32 self-expandable stents. RESULTS Technical success was obtained in 223 lesions (94%). Only 31 occlusions were recanalized (69%). Four periprocedural events occurred (1.2%), 1 major (fatal) stroke, 1 transient ischemic attack and 2 arterial thromboses. At follow-up (mean follow-up: 65.8+/-33.5 months), we had 27 restenoses (12%). Thirteen occurred following angioplasty alone (18.8%) and 14 following angioplasty and stent implantation (8.4%). Primary (PI) and secondary (PII) patencies on an intention to treat basis at 10-year follow-up were 78.1% and 84.5%, respectively. In patients without initial stent placement, the rates were 67.5% and 75.5%, while in those with stents the rates rose to 89.7% and 96.9% (P<0.01). PI for all recanalized lesions were 84.6%, 79.1% without stent, 89.7% with stent (P<0.04) and PII 91.6%, 88.5%, 96.9%, respectively (P<0.02). CONCLUSION Percutaneous transluminal angioplasty is currently the treatment of choice for SA lesions. It is a safe and effective procedure associated with low risks and good long-term results. Stents seem to limit the restenosis rate and improve long-term results.
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Affiliation(s)
- M Henry
- Private Practice Cardiology, Nancy, France.
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Cuisset T, Sarma J, Hamilos M, Goethals M, Heyndrickx G. Coronary-subclavian steal syndrome: an usual cause of refractory unstable angina. Int J Cardiol 2007; 127:e181-2. [PMID: 17706300 DOI: 10.1016/j.ijcard.2007.04.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 04/25/2007] [Indexed: 11/25/2022]
Abstract
A 73 year old woman, with previous history of coronary artery bypass grafting, was admitted for refractory unstable angina. The angiography revealed a significant stenosis of the ostium of the left subclavian artery. The patient underwent successful stenting of the subclavian artery and remained symptom free until hospital discharge a few days later.
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Fergus T, Pacanowski JP, Fasseas P, Nanjundappa A, Habeeb Ahmed M, Dieter RS. Coronary-subclavian steal: presentation and management: two case reports. Angiology 2007; 58:372-5. [PMID: 17626994 DOI: 10.1177/0003319707302500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subclavian stenosis is a highly prevalent and underrecognized clinical entity. In patients with a history of coronary artery bypass grafting utilizing a left internal mammary artery, subclavian artery stenosis can cause coronary-subclavian steal, leading to myocardial ischemia. Traditionally, this has been treated surgically with a vascular bypass operation. Two cases of coronary-subclavian steal syndrome are presented, 1 treated percutaneously with angioplasty and stent, and 1 treated with a combined endovascular-surgical procedure.
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Affiliation(s)
- Todd Fergus
- Department of Cardiovascular Medicine, Loyola University, Maywood, IL, USA
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Pappy R, Kalapura T, Hennebry TA. Anterolateral myocardial infarction induced by coronary-subclavian-vertebral steal syndrome successfully treated with stenting of the subclavian artery. J Invasive Cardiol 2007; 19:E242-5. [PMID: 17712215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A female patient with graft-dependent coronary circulation presented with vertebrobasilar insufficiency and NSTEMI (Non-ST-Elevation Myocardial Infarction) related to a 100 percent stenosis of the left subclavian artery. Our review of the medical literature indicates that this is the first reported case in which a patient presented with an anterolateral NSTEMI and dizziness with subsequent angiographic evidence of both coronary subclavian and vertebral subclavian steal syndromes successfully treated with angioplasty and stenting of the left subclavian artery without any intervention in the coronary arterial tree.
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Affiliation(s)
- Reji Pappy
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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27
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Hugl B, Oldenburg WA, Hakaim AG, Persellin ST. Unusual etiology of upper extremity ischemia in a scleroderma patient: thoracic outlet syndrome with arterial embolization. J Vasc Surg 2007; 45:1259-61. [PMID: 17543693 DOI: 10.1016/j.jvs.2007.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 01/11/2007] [Indexed: 11/24/2022]
Abstract
Although the causes of digital ischemia and necrosis are diverse in women, the most common etiology is connective tissue disease. We describe a patient with scleroderma who presented with arm ischemia secondary to arterial embolization from thoracic outlet syndrome. Her sublavian artery was compressed by the anterior scalene muscle and a cervical rib, leading to a stenosis with poststenotic dilation of the artery. Within the aneurysmal formation was a thrombus, which was probably the source of the distal embolization. The patient underwent surgical resection of the cervical and first rib. The abnormal portion of the subclavian artery was resected and replaced with an interposition graft.
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Affiliation(s)
- Beate Hugl
- Section of Vascular Surgery, Department of Rheumatology, Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA.
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Jordan SE, Ahn SS, Gelabert HA. Differentiation of thoracic outlet syndrome from treatment-resistant cervical brachial pain syndromes: development and utilization of a questionnaire, clinical examination and ultrasound evaluation. Pain Physician 2007; 10:441-52. [PMID: 17525778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The present study was undertaken to determine which factors differentiate patients with a good outcome after treatment for Thoracic Outlet Syndrome (TOS) from patients with a poor outcome. METHODS A total of 85 patients, who were examined during one year, had at least 6 months of follow up after treatment for TOS with either surgery or botulinum chemodenervation. RESULTS Socioeconomic factors of work disability or workers' compensation claims did not differentiate treatment-responsive TOS from treatment-resistant cases. There was no difference between the 2 groups regarding the presence of anomalous anatomy detected by ultrasonography or regarding the presence of subclavian artery flow acceleration or occlusion detected by duplex sonography. Several factors were noted more frequently in treatment-resistant patients: sensory complaints extending beyond lower trunk dermatomes (42% vs. 10%), weakness extending beyond lower trunk myotomes (19% vs. 2%), histories of previous non-TOS surgery of the neck or upper limbs (50% vs.17%), comorbidities of fibromyalgia or complex regional pain syndrome (81% vs. 12%), and depression (35% vs. 10%). Treatment-resistant patients complained about more widespread functional impairments on a validated Cervical Brachial Symptom Questionnaire (CBSQ) than treatment-responsive patients. Resistant cases responded less often to a scalene test block (38% vs. 100%), which is designed to simulate the effects of targeted treatment. CONCLUSION In summary, compared to patients with a good outcome after targeted treatment, patients with a poor outcome had more diffuse complaints and responded less often to a scalene test block.
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Affiliation(s)
- Sheldon E Jordan
- Neurological Associates of West Los Angeles, Santa Monica, CA 90403, USA.
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Aboyans V, Criqui MH, McDermott MM, Allison MA, Denenberg JO, Shadman R, Fronek A. The vital prognosis of subclavian stenosis. J Am Coll Cardiol 2007; 49:1540-5. [PMID: 17418292 DOI: 10.1016/j.jacc.2006.09.055] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 08/21/2006] [Accepted: 09/29/2006] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study sought to assess the prognosis of subclavian stenosis (SS) as a potential marker of total and cardiovascular disease (CVD) mortality. BACKGROUND Subclavian stenosis, diagnosed by a brachial systolic pressure difference (BSPD) > or =15 mm Hg, is associated with an increased prevalence of CVD risk factors. However, the association between SS and mortality is unknown. We hypothesized that a BSPD > or =15 mm Hg would predict an increased risk of CVD events. METHODS We analyzed baseline and longitudinal data from 3 cohorts. Two were recruited from noninvasive vascular laboratories, and the third was a community-dwelling cohort. Multivariate survival models were used to test for an independent association of SS with total and CVD mortality. RESULTS Baseline and follow-up data (mean 9.8 years) were complete in 1,778 participants. Subclavian stenosis was found in 157 (8.8%) subjects. Adjusted for age, gender, ethnicity, and cohort of origin, the presence of SS was significantly associated with increased total and CVD mortality (respectively, hazard ratio [HR] 1.42, p < 0.005; and HR 1.50, p = 0.05). This association persisted after adjustments for CVD risk factors (smoking pack-years, hypertension, diabetes, total/high-density lipoprotein cholesterol ratio, and body mass index) as well as lipid-lowering and antiplatelet therapies (HR 1.40, p < 0.01; and HR 1.57, p < 0.05 for total and CVD mortality, respectively). When any history of CVD or an ankle-brachial index <0.90 were added to the model, SS remained an independent predictor for total mortality (HR 1.34, p = 0.02), with a similar trend for CVD mortality (HR 1.43, p = 0.09). CONCLUSIONS The presence of SS, easily diagnosed by comparing systolic pressures in the left and right arm, predicts total and CVD mortality independent of both CVD risk factors and existent CVD at baseline.
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Affiliation(s)
- Victor Aboyans
- Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, California 92093-0607, USA.
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Malyar NM, Naber C, Erbel R. Angina during upper limb exercise: pathognomonic clinical feature of coronary-subclavian steal syndrome? Heart 2007; 93:308. [PMID: 17322506 PMCID: PMC1861435 DOI: 10.1136/hrt.2006.096487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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31
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Affiliation(s)
- H J Cho
- Department of Neurology, Yonsei University College of Medicine, Seodaemoon-ku, Seoul, Korea
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32
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Vajnar J. Numb fingers and unequal blood pressures in a 58-year-old man. JAAPA 2007; 20:52, 54. [PMID: 17319392 DOI: 10.1097/01720610-200702000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Julie Vajnar
- North Oaks Health System, Hammond, Louisiana, USA
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33
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Tan JWC, Johan BA, Cheah FK, Wong P. Coronary subclavian steal syndrome: a rare cause of acute myocardial infarction. Singapore Med J 2007; 48:e5-8. [PMID: 17245504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The coronary subclavian steal syndrome (CSSS) leading to an acute myocardial infarction (AMI) post-coronary bypass is a rare occurrence. We describe an 83-year-old Indian man who presented with AMI and was subsequently found to have CSSS. The patient had severe stenosis of his left subclavian artery ostium with retrograde flow up his left internal mammary artery graft. Angiographical steal from the left anterior descending artery was demonstrated during coronary angiogram and was thought to be the main contributing cause of his AMI. Percutaneous transfemoral angioplasty and stent implantation was performed to the left subclavian artery, with resolution of myocardial blood flow steal and anterior ischaemia.
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Affiliation(s)
- J W C Tan
- Department of Cardiology, National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752.
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Tanju S, Ustuner E, Erden I, Aytac SK. Right Cervical Aortic Arch and Pseudocoarctation of the Aorta Associated with Aneurysms and Steal Phenomena: US, CTA, and MRA Findings. Cardiovasc Intervent Radiol 2006; 30:146-9. [PMID: 16802075 DOI: 10.1007/s00270-005-0316-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 55-year-old woman presented with right cervical aortic arch with pseudocoarctation of the aorta further complicated by the presence of multiple aneurysms and a high-grade stenosis at the origin of the left subclavian trunk from the aorta causing a discrepancy in blood pressure between the right and left arms. The branching pattern and the resulting complex steal syndromes involving the left carotid and the subclavian system are unique. The computed tomography angiography, magnetic resonance angiography, and Doppler ultrasound findings are described.
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Affiliation(s)
- Sumru Tanju
- Department of Radiology, Ankara University School of Medicine, Ibni Sina Hospital, Sihhiye 06100, Ankara, Turkey.
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35
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Naz I, Sophie Z. Cerebral embolism: distal subclavian disease as a rare etiology. J PAK MED ASSOC 2006; 56:186-8. [PMID: 16711343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Subclavian artery occlusive disease is usually secondary to persistent compression caused by thoracic outlet syndrome (TOS) and rarely due to focal atherosclerosis. Emboli from diseased vessel can flow retrograde to the vertebral or carotid arteries to produce ischemic infarct with or without neurological deficit. We are reporting two cases of distal subclavian artery disease presenting with cerebral embolization, an unusual manifestation. Such surgically correctable lesions producing cerebral emboli and stroke needs consideration while evaluating patients with unusual presentation to prevent further occurrence of stroke.
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Affiliation(s)
- Iram Naz
- Department of Surgery, The Aga Khan University Hospital, Karachi
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36
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Munk PS, Larsen AI, Fjetland L, Nilsen DWT. Acute occlusion of the left subclavian artery causing a non-ST-elevation myocardial infarction with subacute lung edema due to a coronary subclavian steal syndrome—A case report. Int J Cardiol 2006; 108:139-41. [PMID: 16516713 DOI: 10.1016/j.ijcard.2005.03.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 03/12/2005] [Indexed: 11/18/2022]
Abstract
Subclavian artery occlusion causing an anterior non-ST-elevation myocardial infarction in a patient with a left internal mammary artery bypass to the left anterior descending artery. Presentation of a case not previously described in the literature to our knowledge.
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37
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Chen Q, Hou K, Zhang ZX, Zhu YQ, Song TY. Acute occlusion of the left subclavian artery with artery dissection. Chin Med J (Engl) 2006; 119:255-8. [PMID: 16537017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Affiliation(s)
- Qiang Chen
- Department of Neurosurgery, First Hospital of Hebei Medical University, Shijiazhuang 050031, China.
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38
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Huang JS, Picus D, Brown DB. Endovascular Treatment of Vertebral Artery Steal Syndrome from an Arteriovenous Fistula Between the Internal Mammary Artery and Superior Vena Cava. J Vasc Interv Radiol 2006; 17:359-62. [PMID: 16517783 DOI: 10.1097/01.rvi.0000195322.96173.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Vertebrobasilar insufficiency resulting from subclavian steal syndrome and high flow through hemodialysis fistulas has been described. The present report describes a case of vertebral artery steal syndrome from an arteriovenous (AV) fistula between the right internal mammary artery and superior vena cava with the unusual pattern of antegrade flow through the vertebral artery in the setting of classic symptoms of steal. The AV fistula likely developed during earlier cardiac catheterizations. The patient presented with progressively worsening gait and limb ataxia. Angiography demonstrated the AV fistula and antegrade flow through the vertebral artery. Coil embolization of this high-flow fistula resulted in complete resolution of symptoms.
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Affiliation(s)
- Jessica S Huang
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri 63110, USA
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Abstract
BACKGROUND Subclavian artery dissection is a rare entity. It is usually associated with anomalous aortic vasculature. Only with trauma or catheterization procedures is subclavian artery dissection with normal aortic vasculature reported. PATIENT We describe a patient with intrascapular pain, an occipital headache, and 3 distinct infarctions in the nervous system. He had spontaneous subclavian artery dissection with normal aortic vasculature. CONCLUSION Subclavian artery dissections should be suspected in patients with intrascapular pain, occipital or cervical pain, and symptoms within the posterior circulation.
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Affiliation(s)
- Mandeep Garewal
- Department of Neurology, Souers Stroke Institute, Saint Louis University, St Louis, MO 63110, USA.
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40
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Lehmann MF, Mounayer C, Benndorf G, Piotin M, Moret J. Pulsatile tinnitus: a symptom of chronic subclavian artery occlusion. AJNR Am J Neuroradiol 2005; 26:1960-3. [PMID: 16155142 PMCID: PMC8148864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We report the unusual case of pulsatile tinnitus caused by muscular branches of the occipital artery, which developed to supply the distal vertebral artery after subclavian artery occlusion. Anatomical findings and options of endovascular treatment are discussed. To our knowledge, subclavian artery occlusion causing an objective tinnitus has not been reported.
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Liu CP, Ling YH, Kao HL. Use of a pressure-sensing wire to detect sequential pressure gradients for ipsilateral vertebral and subclavian artery stenoses. AJNR Am J Neuroradiol 2005; 26:1810-2. [PMID: 16091534 PMCID: PMC7975163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Endoluminal stent placement is safe and effective in the treatment of symptomatic ostial stenoses of the vertebral artery (VA) and proximal subclavian artery (SCA). However, determining the relative importance of an individual lesion on angiography is difficult when VA and SCA stenoses are concurrent. Pressure-sensing wires help in determining the functional significance of coronary artery stenosis. We present a case of ipsilateral VA and SCA stenoses in which a pressure-sensing wire was used in making interventional decisions.
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Affiliation(s)
- Chung-Pin Liu
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital
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42
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Abstract
Subclavian artery stenosis (SAS) is a rare lesion accounting for nearly 2.5% of all extracranial arterial occlusions. Symptoms from SAS usually relate to subclavian steal, and include syncope, vertigo, ataxia, and, rarely, upper limb paralysis or hemipareses. Upper extremity ischemia may result in intermittent or constant arm pain. The majority of patients with SAS are asymptomatic. Upper extremity ischemia is particularly unusual. More commonly, patients with significant SAS have symptoms of cerebral ischemia, which are usually triggered by vigorous motion of the arm on the side of the severe proximal subclavian obstruction. Stress exercise radionuclide imaging appears to be a valuable modality in determining the functional significance of SAS. We describe a case in which radionuclide imaging with thallium-201 after stress of the upper extremities was used for risk stratification of subclavian stenosis, and to help decide treatment options.
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Itoh A, Kobayashi J, Tagusari O, Kitamura S. Aortic valve replacement concomitant with multiple extra-anatomical bypasses for a patient with aortic valve insufficiency having Takayasu's arteritis. Eur J Cardiothorac Surg 2005; 27:1114. [PMID: 15896629 DOI: 10.1016/j.ejcts.2005.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Revised: 02/05/2005] [Accepted: 02/08/2005] [Indexed: 11/29/2022] Open
Affiliation(s)
- Akinobu Itoh
- Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Sita, Osaka 565-8565, Japan
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44
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Matsuda N, Matsuura Y, Soeta T, Shibano K, Endo K, Sato Y, Takahashi K, Yokoyama H, Yamamoto T. [Evaluation of neurosonography for a case of brainstem transient ischemic attack (TIA) due to proximal subclavian artery stenosis, with favorable outcome after axillo-axillary bypass grafting]. Rinsho Shinkeigaku 2005; 45:372-5. [PMID: 15960175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
We report an 82-year-old man with crescendo brainstem TIA and left upper-limb ischemia due to the left proximal subclavian artery stenosis. Angiography revealed that the left proximal subclavian artery was stenotic. The right vertebral artery was considered to be aplastic or occlusive. Neurosonography, especially the echo-Doppler study of the left vertebral artery, showed that the subclavian artery steal phenomenon did not occur. This study has enabled us to opt for axillo-axillary bypass. We preferred to avoid percutaneous transluminal angioplasty in order to avoid the risk of embolization. The patient received the axillo-axillary bypass operation. He has been free of TIAs and the left upper-limb ischemia since the surgery. We have evaluated his blood circulation fully, by comparing his state before and after the axillo-axillary bypass grafting.
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45
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Rigatelli G, Rigatelli G. Screening angiography of supraaortic vessels performed by invasive cardiologists at the time of cardiac catheterization: indications and results. Int J Cardiovasc Imaging 2005; 21:179-83. [PMID: 16015426 DOI: 10.1007/s10554-004-3900-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 09/22/2004] [Indexed: 10/25/2022]
Abstract
An aging population makes multiple vascular distributions more likely in patients arriving at the cath lab for coronary artery angiography or complete cardiac catheterization. Whether or not screening angiography of supraaortic vessels can be performed at the time of cardiac catheterization by the invasive cardiologist is still debatable. We sought to determine safety and utility of performing angiography of supraaortic vessels during cardiac catheterization. Medical records of all patients undergoing combined coronary and noncoronary angiography between May 1998 and December 2002 was retrospectively reviewed. One hundred and forty patients (80 males, mean age 67.8 +/- 5.4 years) underwent combined cardiac catheterization and angiography of supraaortic vessels. Carotid artery angiography was performed at the same time of cardiac catheterization in 62 patients and subclavian artery angiography in the other 78 patients. Significant findings were reported in 32 (22.8%) patients. Complications included 1 transient ischemic attack and 2 carotid spasm resolved with nitrates infusion. In most cases the same standard catheters used during coronary angiography were used also for noncoronary angiography (119 patients, 85%). The incidence of significant angiographic findings and the relatively frequent association of CAD with supraaortic vessel atherosclerosis supports combined cardiac catheterization and angiography of supraaortic arteries but only in patients with multivessel coronary artery disease.
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Ribichini F, Maffè S, Ferrero V, Cotroneo A, Vassanelli C. Percutaneous Angioplasty of the Subclavian Artery in Patients with Mammary‐Coronary Bypass Grafts. J Interv Cardiol 2005; 18:39-44. [PMID: 15788053 DOI: 10.1111/j.1540-8183.2005.00359.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Severe coronary artery disease often coexists with peripheral vascular atherosclerosis. The assessment of the supra-aortic circulation in candidates for surgical coronary revascularization is of clinical relevance, and after intervention the patency of the supra-aortic trunks should be regularly evaluated in the clinical follow-up. We describe three cases of coronary artery disease treated with surgical revascularization using the internal mammary artery and concomitant atherosclerotic disease of the subclavian artery. The clinical presentation, the diagnostic procedures, and the therapeutic approach by means of percutaneous transluminal angioplasty of the subclavian artery are described and discussed.
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Affiliation(s)
- Flavio Ribichini
- Division of Cardiology, Università del Piemonte Orientale, Ospedale Maggiore della Carità, Novara, Italy.
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47
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Akdemir R, Ozhan H, Tataroglu C. Coronary-subclavian steal syndrome presenting with chest pain and syncope. Acta Cardiol 2004; 59:665-7. [PMID: 15636453 DOI: 10.2143/ac.59.6.2182836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The present case is a 68-year-old patient with complaints of chest pain and syncopal attacks during physical activity of the left arm, for the last six months. He had a coronary artery bypass graft operation 10 years ago. Angiographic examination demonstrated total occlusion of the subclavian artery. The subclavian artery was stealing blood from the left anterior descending artery via the left internal mammary artery and from the brain via the left vertebral artery, leading to the diagnosis of subclavian artery steal syndrome; a rare cause of coronary and cerebral ischaemia.
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Affiliation(s)
- Ramazan Akdemir
- Abant Izzet Baysal University, Düzce Medical School, Department of Cardiology, Düzce, Turkey.
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48
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Wood F, Mann JT, Jobe RL, Arrowood M. Transradial subclavian and coronary stenting in a single procedure. J Invasive Cardiol 2004; 16:596-8. [PMID: 15505360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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49
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Affiliation(s)
- Paolo Rampini
- Neurosurgical Operative Unit, Department of Neurological Sciences, Ospedale Maggiore, IRCCS, University of Milan, Milan, Italy.
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50
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Abstract
BACKGROUND Subclavian steal syndrome is a systemic entity that is well-documented in the medical literature. It occurs when the subclavian artery becomes stenosed or occluded and blood flow is reversed in the ipsilateral vertebral artery. This siphoning or "stealing" of blood has traditionally been thought to cause symptoms of vertebral-basilar insufficiency. Recent literature indicates that subclavian steal syndrome is often asymptomatic, but may be associated with a wide variety of signs and symptoms of vertebro-basilar, carotid, or upper extremity ischemia, and that the manifestation of the condition is probably dependent on the patency of the other cranial arteries. CASE REPORTS This report describes three patients who underwent comprehensive eye examinations and who had been previously diagnosed with subclavian steal phenomenon. The initial symptoms included: unilateral Hollenhorst plaque, unilateral fibrino-platelet plaque, and one patient with no symptoms These patients were followed for their ocular conditions concurrently with their physicians following their systemic circulatory disease. Signs and symptoms, imaging and laboratory tests, and management are discussed. CONCLUSIONS Subclavian steal syndrome is a systemic condition that may manifest ocular signs and symptoms that optometrists should recognize, and which merits referral for systemic evaluation and treatment as necessary Patients who manifest signs and symptoms of vertebro-basilar insufficiency, carotid territory ischemia, or ocular symptoms of atherosclerosis may be diagnosed with subclavian steal syndrome as evaluation of the extracranial arteries is pursued.
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Affiliation(s)
- Cindy F Lum
- West Los Angeles VA Healthcare Center, West Los Angeles VA Healthcare Center, Los Angeles, California 90073, USA
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