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Schematic diagram showing the retrograde from the left coronary artery through the mammary artery bypass grafts in a patient with left subclavian artery Stenosis. (Reproduced and modified with permission from Takach et al., 2006).
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Subclavian 'steal' phenomenon is a function of the proximal subclavian artery (SA) steno-occlusive disease, with subsequent retrograde blood flow in the ipsilateral vertebral artery (VA). The symptoms from the compromised vertebrobasilar and brachial blood flows constitute the subclavian steal syndrome (SSS), and include paroxysmal vertigo, drop at...
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... pathophysiologic mechanism behind the subclavian steal via the vertebral artery is similar to the one involving coronary arteries, except that different vessels are involved. The cor- onary subclavian steal syndrome (CSSS) has been defined as the reversal of flow in a previously constructed internal mammary artery (most often left internal mammary artery) and left coronary artery bypass graft, leading to myocardial ischemia [4] (Figure 2). The proximal subclavian artery ste- nosis in this scenario causes reversed flow in the ipsilateral IMA coronary artery graft. ...Citations
... 1) The subclavian steal phenomenon (SSP) is rarely symptomatic and is often detected incidentally. 2) Asymptomatic SSP during dialysis is rare (2.6%), 3) as are symptomatic cases, 4) with only five cases reported so far. Among these cases, there are no reports of acute cerebral infarction. ...
We present a case of pontine infarction caused by subclavian steal phenomenon (SSP) due to subclavian artery stenosis (SAS) and an arteriovenous shunt in the forearm in a 74-year-old man with hemodialysis and stenting for SAS with improvement of SSP. He developed dysarthria during dialysis. He was admitted to our hospital and diagnosed with a pontine infarction. As the basilar artery appeared to be occluded on magnetic resonance angiography, an emergency diagnostic angiography was performed. Aortagram showed severe stenosis of the left subclavian artery. Right vertebral artery (VA) angiogram revealed retrograde arterial blood flow from the right VA to the left VA via the VA union, which suggested SSP. In addition, the steal was augmented by an ipsilateral hemodialysis arteriovenous shunt. Percutaneous subclavian artery stenting was performed 12 days later, and there was no recurrence of symptoms in the follow-up period. To our knowledge, this study is the first to report a patient with SSP who developed a pontine infarction due to SAS and an arteriovenous shunt during hemodialysis and who underwent subclavian artery stenting and had a good outcome.
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... In addition, symptoms are the prerogative of adulthood, with symptoms appearing at approximately 48 years, with significant differences between men (44.9 years) and women (54 years). Several authors such as Osiro et al. [71] and Mochizuki et al. [72] associate ARSA with hemodynamic changes at the level of the upper limb, as well as at the vertebro-basilar level. The "subclavian steal syndrome" is clinically characterized by both central and peripheral ischemic and neurological phenomena. ...
Background: The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5–4.4%. Most cases are incidental due to minimal clinical manifestations. Computer tomography (CT) is important in diagnosing and evaluating these patients. Materials and Methods: We conduct a computerized search in two databases, PubMed and EMBASE, for articles published between 1 January 2022 and 31 December 2023, PROSPERO code: CRD42024511791. Eligible for inclusion were case reports and case series that presented the aberrant origin of the right subclavian artery. The main outcome was the highlighting of the morphological types of ARSA. In this context, we proposed a new classification system of this anomaly. The secondary outcome was the evaluation of the demographic distribution of the lusoria artery. Results: Our search identified 47 articles describing 51 patients with ARSA. The typical course for ARSA is retroesophageal, being registered in 49 out of 51 patients. This malformation is frequently associated with Kommerell diverticulum (15 out of 51), troncus bicaroticus (7 out of 51), and aberrant origins of the right vertebral artery (7 out of 51). We observed a higher incidence of the condition among women (32 out of 51) compared to men (19 out of 51). From a demographic point of view, ARSA is more frequent in the “44 to 57 years” and “58 to 71 years” age ranges. Conclusions: ARSA is a congenital malformation resulting from a defect in the development of the aortic arches. The imaging studies such as computer tomography play a defined diagnostic role.
... Out of these, 168 people were diagnosed as having "true" subclavian steal syndrome. 5,6 Early in the 19th century, the idea that vertebral circulation could make up for a blocked subclavian artery was discovered. Harrison first acknowledged the significance of the vertebral-vertebral circulation in subclavian artery obstruction in 1829. ...
... Postoperatively, brachial blood pressure is compared, and patients are evaluated for neurological impairments. [3][4][5][6][7] Endovascular therapy is the most popular method for treating lesions of the proximal subclavian artery. ...
... Primary 4-year stent patency rates varied, and patients with lengthier stents had a higher risk of problems. [5][6][7][8] ...
Subclavian steal syndrome is a diagnosis that is thought to be relatively uncommon even though its occurrence is not well understood. Some individuals may experience crippling symptoms of arm ischemia and vertebral-basilar insufficiency due to subclavian steal, which is more frequent than the accompanying illness. Patients with uneven arm blood pressure or unilaterally faint pulses should be evaluated for subclavian steal. Although it is not always necessary to check the blood pressure and pulse on both sides, they become significant when these measurements differ and are accompanied by vertebral-basilar or arm ischemia symptoms. Although subclavian steal does not significantly increase the risk of stroke, it is nevertheless essential to recognize and treat asymmetric blood pressure and weak pulses as these may be signs of subclavian steal syndrome. This page thoroughly analyses the aetiology of subclavian steal syndrome, signs, symptoms, diagnosis, and available treatments.
... The incidence of subclavian steal syndrome in the UK population is about 1.3%, and is more common among men than among women. Among people with neurological symptoms undergoing Doppler examination of the vessels of the head and neck, the frequency of this pathology is approximately 17% [5][6][7]. ...
The authors presented a clinical case of left subclavian steal syndrome in a 62-year-old man. The main complaints were dizziness, tinnitus, memory loss and unsteady gait. The patient had severe concomitant pathology: coronary heart disease, hypertension, heart failure. X-ray endovascular technologies (balloon dilatation and stenting) made it possible to completely restore blood flow in the affected segment. After treatment, the above complaints disappeared. Minimally invasive X-ray endovascular techniques have particular benefits in patients with severe comorbid pathology.
... Subclavian steal syndrome (SSS) is defined as retrograde blood flow in the vertebral artery due to proximal subclavian artery occlusion. 1 The prevalence of this condition is believed to be between 0.6% and 6.4% and is four times more frequent on the left side. 1 Most patients are asymptomatic. Symptoms usually develop once the stenosis has become severe enough to result in vertebrobasilar insufficiency or upper extremity ischemia. ...
... 1 The prevalence of this condition is believed to be between 0.6% and 6.4% and is four times more frequent on the left side. 1 Most patients are asymptomatic. Symptoms usually develop once the stenosis has become severe enough to result in vertebrobasilar insufficiency or upper extremity ischemia. ...
... SSS results from a narrowed subclavian artery, causing reversed blood flow in the vertebral artery and stealing blood from the unaffected subclavian artery to supply the upper limb. 1 A difference of >20 mm Hg is usually noted between the two upper extremities. 1 Most patients are asymptomatic because the residual blood flow remains greater than that required for daily activities. Symptoms are more frequent in patients with a higher difference in blood pressure, with 38.5% of patients with a >50-mm Hg difference presenting with symptoms. ...
Bilateral carotid artery stenosis in the context of subclavian steal syndrome is an extremely rare finding. We hereby report the case of a 75-year-old who presented with a transient ischemic attack. Bilateral internal carotid stenosis associated with left subclavian steal syndrome was diagnosed. A left internal carotid endarterectomy was performed under loco-regional anesthesia. Inflation of a blood pressure cuff reversed the neurological symptoms that appeared following internal carotid clamping. This rarely reported case remains a challenge because of its complex mechanisms and multiple risk factors. It highlights the importance of the surgical strategy adopted and a good initial assessment.
... Because of this unusual blood pressure differential, computed tomography angiography (CTA) of the upper extremity was performed, which showed total occlusion of the left subclavian artery at the origin (Fig. 1). Since the patient had no neurological signs or abnormal findings on brain computed tomography (CT) scan, it was inferred that the syncope occurred due to subclavian steal syndrome due to total occlusion of the left subclavian artery [3]. ...
... The patient visited our hospital with syncope as the chief complaint, and the neurological signs and radiologic images showed that the cause of the symptom was subclavian steal syndrome rather than a brain abnormality. Subclavian steal syndrome is a temporary phenomenon of vertebrobasilar ischemia caused by occlusion or stenosis of the proximal subclavian artery, which "steals" blood flow from the contralateral vertebral artery, creating retrograde flow in the ipsilateral vertebral artery [3,10]. Syncope may occur due to this transient cerebral ischemia. ...
Takayasu arteritis (TA) is a disease that causes inflammation and stenosis of medium to large blood vessels. We report a case of a 50-year-old female patient with newly developed hypertension, syncope, and claudication of the extremities. Total occlusion of the left subclavian artery at the origin was found and significant stenosis of the right common iliac artery was revealed by hemodynamic analysis. She was successfully treated with percutaneous angioplasty for multiple peripheral arterial diseases and was finally diagnosed with TA. In consultation with a rheumatologist, medical treatment for TA was initiated, the patient's hypertension disappeared, and her claudication symptoms improved.
... It occurs when the subclavian artery, usually the left, is occluded proximal to the origin of the vertebral artery. 1 Consequently, the distal subclavian artery 'steals' blood from the ipsilateral vertebral artery resulting in retrograde flow. 1 The phenomenon was first described by Contorni and then Reivich in 1960 and 1961, respectively, and the term 'subclavian steal syndrome' was then first coined by Fisher in 1961. [2][3][4] Asymptomatic presentation (ie, subclavian steal phenomenon) is the most common clinical picture and does not warrant intensive or invasive evaluation or treatment. ...
... It occurs when the subclavian artery, usually the left, is occluded proximal to the origin of the vertebral artery. 1 Consequently, the distal subclavian artery 'steals' blood from the ipsilateral vertebral artery resulting in retrograde flow. 1 The phenomenon was first described by Contorni and then Reivich in 1960 and 1961, respectively, and the term 'subclavian steal syndrome' was then first coined by Fisher in 1961. [2][3][4] Asymptomatic presentation (ie, subclavian steal phenomenon) is the most common clinical picture and does not warrant intensive or invasive evaluation or treatment. ...
... 6 SSS implies clinical features of significant arterial insufficiency to either the brain, upper limb or both. 1 It results in exercise-induced numbness, pain, fatigue, coldness and paraesthesia in the upper limb and less often neurological symptoms of vertebrobasilar insufficiency (VBI): vertigo, dizziness, ataxia, syncope and visual changes. 1 7 Symptomatic SSS has a prevalence ranging from 0.6% to 6.4%. 1 We herein report a case of a woman who presented with transient left upper limb weakness, pain, coolness and paraesthesia, and was subsequently found to have a variant of SSS. ...
A woman in her 70s presented to her general practitioner (GP) with a 3-month history of left upper arm pain and weakness. A significant difference in bilateral blood pressures was noted and a further history elicited coolness in her left arm without functional compromise. A CT angiography revealed variant subclavian steal syndrome with a subclavian arterial stenosis, which was proximal to both the internal mammary and thyrocervical trunk and her left vertebral artery originating from the aortic arch. She was referred to a vascular surgeon but declined surgical intervention. Her symptoms remain stable with 6-month follow-up from her GP. This case highlights the importance of considering vascular aetiologies in upper limb pain and weakness. Our case reviews the differential diagnoses of upper limb pain and weakness, consequently leading to the discussion of an interesting variant of subclavian stenosis.
... Subclavian steal syndrome is the occlusion of the proximal subclavian artery, which leads toflow reversal in the ipsilateral vertebral artery and the "stealing" of blood from the contralateral vertebral artery [4]. Subsequently, this causes arterial insufficiency of the brain and upper extremity supplied by the occluded vessel.Clinical features of subclavian steal syndrome include lightheadedness, syncope, orthostasis, headaches, strokes, and convulsions [6]. ...
Takayasu arteritis (TAK) is a rare but well-known inflammatory disease affecting large vessels that leads to thickening, narrowing, occlusion, or dilation of the affected arteries. The overall effect of the disease is arterial insufficiency of the brain and/or the distal part of the affected vessel. Subclavian steal syndrome has been observed as a form of presentation where there is occlusion of the proximal subclavian artery that results in a reversal of flow in the ipsilateral vertebral artery, consequently diverting or ‘stealing’ blood from the contralateral vertebral artery. Our patient is a 34-year-old Caucasian female presenting with subclavian steal syndrome as the initial presentation of TAK. She presented to the emergency department following a syncopal episode and six months prior history of intermittent lightheadedness, vertigo, left upper extremity pain, numbness, and tingling which was said to be aggravated with activity and alleviated with rest. Examination findings revealed non-palpable left brachial and radial pulses of the upper limb with an inaudible blood pressure reading on the ipsilateral side and blood pressure of 113/70 mmHg on the contralateral arm.
Investigation revealed elevated acute phase reactant, normocytic anemia, and inflammation of the aorta on imaging. She was evaluated by the vascular surgery team who recommended medical management. The patient was managed with steroids and methotrexate, and her symptoms improved significantly with the normalization of laboratory findings. She is currently being followed up by the vascular surgery and rheumatology teams. We emphasize the importance of understanding the varied clinical spectrum of TAK and the need to have a high index of suspicion for TAK in a young female with recurrent syncope and unilateral upper extremity intermittent numbness and paresthesia.
... Так, при постепенном сдавлении, формирующейся окклюзии ПА, вызванной опухолевым процессом, или при атеросклеротическом поражении не возникает симптомов вертебробазилярной недостаточности (ВБН). Более того, при окклюзии первого сегмента подключичной артерии с формированием стилл-синдрома по ПА не наблюдается тяжелых клинических проявлений ВБН, и это несмотря на ретроградный кровоток по ПА, обеспечивающий кровоснабжение соответствующей верхней конечности [3]. ...
Цель. Оценить ближайшие результаты наружносонно-позвоночного перемещения в V3 при позиционных нарушениях кровотока в вертебробазилярном бассейне, обусловленных поражением V2-сегмента ПА. Материалы и методы. В исследование включено 33 пациента с показаниями к НСА – ПА перемещению в V3. Предложена методика выключения из кровотока скомпрометированного V2-сегмента позвоночной артерии (ПА) путем ее обходного шунтирования за счет перемещения наружной сонной артерии (НСА) в V3-сегмент ПА (НСА – ПА). Результаты. Летальных исходов, инсультов в ближайшем послеоперационном периоде не отмечено. Повреждения черепных нервов, кровотечений не наблюдалось. Одна из основных жалоб в послеоперационном периоде – интенсивный болевой синдром. Отмечено субъективное улучшение состояния к моменту выписки из стационара, проявляющееся снижением симптомов головокружения. В послеоперационном периоде не отмечалось появления внезапных падений пациентов (dropp-атак) при проведении пробы де Клейна с поворотом и запрокидыванием назад головы. Выявлена тенденция к улучшению сосредоточенности пациентов на выполнении простых задач (тест Фолстейна). Достоверные различия, связанные с отсутствием снижения кровотока при пробе де Клейна, имели место в ближайшем послеоперационном периоде (p=0,03). Значения теста с фотосенсибилизацией значимо увеличивались в ближайшем послеоперационном периоде (p=0,048). Отмечено улучшение качества жизни пациентов уже через 10 дней от момента операции, за исключением уровня боли. Показатель боли сравнивается с исходным уже к 30-дневному периоду от момента операции. Заключение. Наружносонно-позвоночное перемещение может быть методом выбора при лечении ВБН, обусловленной экстравазальной компрессией ПА в V2-сегменте, при невозможности точной локализации компрессионного механизма или протяженного воздействия на ПА в этом сегменте.
Purpose. To evaluate the immediate results of external carotid-vertebral (ECA-VA) movement in V3 in case of positional blood flow disorders in the vertebrobasilar area caused by damage to the V2 segment of the VA. Materials and methods. The study included 33 patients. We proposed a technique for exclusion of the compromised V2 segment of the VA from the bloodstream by bypassing it by moving the external carotid artery (ECA) to the V3 segment of the VA. Results. There were no lethal outcomes or strokes in the immediate postoperative period. Damage to the cranial nerves, bleeding was not observed. One of the main complaints in the postoperative period is intense pain. There was a subjective improvement in the condition by the time of discharge from the hospital, manifested by a decrease in the symptoms of dizziness. In the postoperative period, the appearance of dropp-attacks, falls during the De Klein test was not noted. A tendency to improve the concentration of patients on performing simple tasks was revealed (Folstein test). The absence of a decrease in blood flow during the test with turning and tilting back the head (De Klein) was noted; there were significant differences already in the immediate postoperative period (p=0.03). The test with photosensitization had a significant increase already in the immediate postoperative period (p=0.048). An improvement in the quality of life of patients was noted already 10 days after the operation, with the exception of the level of pain. The pain index is compared with the baseline already by the 30-day period from the moment of surgery. Conclusion. External carotid-vertebral movement may be the method of choice in the treatment of VBI caused by extravasal compression of the VA in the V2 segment, when it is impossible to accurately localize the compression mechanism or an extended an impact on the VA in this segment.
... It is possible that the focal narrowing of the left arch near the origin of the left subclavian artery and its particularly aberrant course, generated blood-flow turbulency which, we infer, favored the developing of the plaque [15] . Rare cases of congenital subclavian steal have been described in literature, and some of them were associated to a presence of an anomalous right-sided aortic arch [16] . ...
In this paper, we describe a rare case of double aortic arch with dominant right arch with focal narrowing of the distal left arch and descendent aorta's dilatation, associated with pulmonary embolism and left subclavian steal syndrome, found in a 59-year-old woman with a history of dysphagia, chest discomfort, and left arm claudication. Diagnosis of this condition was made with a sub-optimal pulmonary CT-angiography with a combination of characteristic features of double aortic arch and vascular rings. Being aware of these conditions is crucial to avoid misclassification and surgical and endovascular complications.
