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Mansour M, Raffoul L, Alattar O, Deeb H, Albainy L, Taqem S. Subclavian steal syndrome: a case study of diagnosis, management, and successful surgical resolution. J Surg Case Rep 2024; 2024:rjae280. [PMID: 38706487 PMCID: PMC11068443 DOI: 10.1093/jscr/rjae280] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024] Open
Abstract
Subclavian steal syndrome (SSS) is a rare vascular condition characterized by retrograde blood flow in the vertebral artery, often discovered incidentally in asymptomatic patients. We present a 65-year-old male with recurrent transient ischemic attacks (TIAs) attributed to 99% stenosis at the origin of the left subclavian artery, leading to SSS. Diagnostic modalities included duplex ultrasound, confirming inverted left vertebral artery flow, and multi-slice computed tomography angiography, confirming the diagnosis. Despite an unsuccessful attempt at balloon angioplasty, successful vascular surgery was performed, establishing a left carotid-vertebral artery bypass. The patient recovered well without complications. This case underscores the importance of considering SSS in TIA cases, utilizing non-invasive diagnostic tools, and highlighting the successful management of symptomatic SSS through surgical intervention.
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Affiliation(s)
- Marah Mansour
- Faculty of Medicine, Tartous University, 8th March street, 7th project, Tartous, Syrian Arab Republic
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. SW Rochester, MN 55905, United States
| | - Lutfallah Raffoul
- Faculty of Medicine, Al Andalus University for Medical Sciences, Al-Qadmus street, Tartous, Syrian Arab Republic
| | - Omar Alattar
- Faculty of Medicine, Damascus University, Fayez Mansour street, Damascus, Syria
| | - Hala Deeb
- Faculty of Medicine, Damascus University, Fayez Mansour street, Damascus, Syria
| | - Laila Albainy
- Department of Plastic Surgery, Al Mujtahid hospital, Khaled Ibn Alwalid street, Damascus, Syria
| | - Saleh Taqem
- Department of Cardiology, Alasad University hospital, 17 April street, Damascus, Syria
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Wang G, Wang J, Zhang H, Wang H, Meng Q, Song L, Zhou G. Case Report: Right aortic arch with isolation of left brachiocephalic artery and ventricular septal defect. Front Cardiovasc Med 2024; 11:1381222. [PMID: 38711793 PMCID: PMC11072187 DOI: 10.3389/fcvm.2024.1381222] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/05/2024] [Indexed: 05/08/2024] Open
Abstract
Right aortic arch with isolation of left brachiocephalic artery is a rare congenital aortic arch anomaly. Herein, we reported a case of this rare anomaly with ventricular septal defect in a 9-month-old infant. We successfully reconstructed the islolated left brachiocephalic artery and repaired the ventricular septal defect in one stage.
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Affiliation(s)
- Gang Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Jieqiong Wang
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Hongjie Zhang
- Department of Radiology, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Hui Wang
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Qiang Meng
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Linhong Song
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Gengxu Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
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3
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Nashnoush M, Sahak H, Shin Y, Ahimsadasan R, Raveendran Y, Hanna J, Nurani K. Innominate artery occlusion: a case study. J Ultrason 2024; 24:20240008. [PMID: 38419840 PMCID: PMC10897371 DOI: 10.15557/jou.2024.0008] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024] Open
Abstract
Aim of the study The aim of this case report is to evaluate carotid duplex and hemodynamic patterns in an asymptomatic male patient with innominate artery occlusion. Innominate artery occlusion is a rare clinical entity that can lead to a range of cerebrovascular symptoms, including arm claudication, subclavian steal syndrome, and stroke. The case report emphasizes key learning points in diagnosing innominate artery occlusion using imaging and physiological methods. Case description A 64-year-old asymptomatic male patient with a history of carotid bruit, hypertension, coronary artery bypass grafting, aortic aneurysm, hyperlipidemia, mild aortic stenosis, long-term tobacco use, and a body mass index of 24 was referred for a carotid ultrasound. Conclusions Innominate artery occlusion is a rare condition requiring a comprehensive assessment of collateralization before any intervention is attempted. Considering waveform features such as transient end-diastolic flow reversal and tardus parvus, along with brachial pressures and transcranial Doppler, can assist in evaluating the extent of disease.
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Affiliation(s)
| | - Hosna Sahak
- Department of Human Biology, Life Sciences, University of Toronto, Toronto, Canada
| | - Yoojin Shin
- Department of Life Sciences, McMaster University, Toronto, Canada
| | - Roja Ahimsadasan
- Schulich School of Medicine and Dentistry, University of Western Ontario, Toronto, Canada
| | - Yanuga Raveendran
- Schulich School of Medicine and Dentistry, University of Western Ontario, Toronto, Canada
| | - John Hanna
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Khulud Nurani
- School of Medicine, University of Nairobi, Nairobi, Kenya
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Hashimoto K, Harada M, Yamada Y, Kanno T, Kanno Y, Kamijo Y. Impact of Vascular Access Flow Suppression Surgery on Cervical Artery Circulation: A Retrospective Observational Study. J Clin Med 2024; 13:641. [PMID: 38337335 PMCID: PMC10856206 DOI: 10.3390/jcm13030641] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
Vascular access (VA) flow suppression surgery augments VA flow resistance and can increase other circulation flows hindered by high-flow VA. However, whether VA flow suppression surgery affects cervical circulation has rarely been reported. We aimed to determine the effect of VA flow suppression surgery on the cervical circulation in patients with high-flow VA. This single-center, retrospective, observational study included 85 hemodialysis patients who underwent VA flow suppression surgery at the Kanno Dialysis and Access Clinic between 2009 and 2018. Blood flow in the VA, bilateral vertebral arteries, and common carotid artery was measured before and after VA flow suppression surgery. The VA flow decreased from 1548 mL/min to 693 mL/min postoperatively. The flow of the vertebral artery on the VA side increased from 55 mL/min to 81 mL/min. The flow in the bilateral common carotid arteries also increased. Patients whose symptoms improved postoperatively showed better improvement in the vertebral artery on the VA side. VA flow suppression surgery in patients with high-flow VA increases the flow of the vertebral artery on the VA side and of the bilateral common carotid arteries. High-flow VA can hinder the vertebral and common carotid circulation.
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Affiliation(s)
- Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; (K.H.); (M.H.); (Y.Y.)
| | - Makoto Harada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; (K.H.); (M.H.); (Y.Y.)
| | - Yosuke Yamada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; (K.H.); (M.H.); (Y.Y.)
| | - Taro Kanno
- Kanno Dialysis and Vascular Access Clinic, 2-17-5 Tsukama, Matsumoto 390-0821, Japan; (T.K.); (Y.K.)
| | - Yutaka Kanno
- Kanno Dialysis and Vascular Access Clinic, 2-17-5 Tsukama, Matsumoto 390-0821, Japan; (T.K.); (Y.K.)
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; (K.H.); (M.H.); (Y.Y.)
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Wenkel M, Halloum N, Izzat MB, Ali-Hasan-Al-Saegh S, Duerr GD, Kriege M, Stamenovic D, Treede H, El Beyrouti H. Long-Term Outcome of Carotid-Subclavian Bypass in the Management of Coronary- Subclavian Steal Syndrome. Vasc Endovascular Surg 2024; 58:29-33. [PMID: 37366167 DOI: 10.1177/15385744231186272] [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] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The presence of a significant left subclavian artery stenosis may occasionally lead to blood flow reversal through a LIMA-to-coronary artery bypass graft during left arm exertion; with "stealing" of myocardial blood supply. The aim of this study was to review our experience with carotid-subclavian bypass in patients with post-CABG coronary-subclavian steal syndrome. METHODS This is a retrospective review of all patients who underwent carotid-subclavian bypass grafting for post-CABG coronary-subclavian steal syndrome at Mainz University Hospital between 2006 and 2015. Cases were identified in our institutional database, and data were retrieved from surgical records, imaging studies, and follow-up records. RESULTS Nine patients (all males, mean age of 69.1 years) underwent surgical treatment for post-CABG coronary-subclavian steal syndrome. Medium interval between original CABG and carotid-subclavian bypass grafting was 86.1 months. There were no perioperative deaths, strokes or myocardial infarctions. At a mean follow-up period of 79.9 months, all patients remained asymptomatic and all carotid-subclavian bypass grafts remained patent. One patient required stenting of a common carotid artery stenosis proximal to the graft anastomosis site, and coronary artery stenting was required in four patients in regions other than those supplied by the patent LIMA graft. CONCLUSION Carotid-subclavian bypass surgery is a safe treatment option even in patients with multivessel disease and severe comorbidities and should be taken into consideration in patients who are deemed fit for surgery and those who would benefit from the excellent long-term patency rates.
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Affiliation(s)
- Martin Wenkel
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Nancy Halloum
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | | | - Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Georg Daniel Duerr
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Hazem El Beyrouti
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
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Rodríguez-Pérez Á, Tello-Diaz C, Vergara-Budding AC, Fernández-Vinzenzi C, Hakim Moustafa A, Acebes Pinilla C, Ginel-Iglesias A, Barros-Membrilla AJ, Dilme-Muñoz JF. Case Report: Kommerell's diverticulum and left aberrant subclavian artery stenosis hybrid treatment with branched aortic stent-graft. Front Cardiovasc Med 2023; 10:1309839. [PMID: 38155991 PMCID: PMC10754508 DOI: 10.3389/fcvm.2023.1309839] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/21/2023] [Indexed: 12/30/2023] Open
Abstract
Kommerell's diverticulum in association with left or right aberrant subclavian arteries is a rare finding and is challenging to treat. Contemporary surgical and endovascular techniques provide a broad arsenal of possible treatments. Imaging techniques and modeling technology allow a more personalized strategy for each patient. In this case, we present a symptomatic patient with a Kommerell's diverticulum and a left aberrant subclavian artery complicated by proximal stenosis and poststenotic aneurysm. A hybrid technique using a single-branched thoracic stent-graft (Castor, MicroPort Medical, Shanghai, China) in combination with a surgical left subclavian-carotid bypass and endovascular occlusion of the poststenotic aneurysm using a vascular plug device (Amplatzer Vascular Plug, Abbott, Chicago, United States) was performed. This approach was planned and facilitated by the use of a 3D model. Alternative treatment options and the strengths of this approach are briefly reviewed and discussed.
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Affiliation(s)
- Álvaro Rodríguez-Pérez
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, UAB, IIB Sant Pau, CIBERCV ISCIII, Barcelona, Spain
| | - Cristina Tello-Diaz
- Department of Vascular and Endovascular Surgery, Hospital de la Santa Creu I Sant Pau, Institute of Biomedical Research (II-B Sant Pau), CIBER CV, UAB, Barcelona, Spain
| | - A. Carolina Vergara-Budding
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, UAB, IIB Sant Pau, CIBERCV ISCIII, Barcelona, Spain
| | | | - Abdel Hakim Moustafa
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, UAB, IIB Sant Pau, CIBERCV ISCIII, Barcelona, Spain
- Dimension Lab, Hospital de la Santa Creu I Sant Pau, UAB, Barcelona, Spain
| | | | | | - Antonio J. Barros-Membrilla
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, UAB, IIB Sant Pau, CIBERCV ISCIII, Barcelona, Spain
| | - Jaime Felix Dilme-Muñoz
- Department of Vascular and Endovascular Surgery, Hospital de la Santa Creu I Sant Pau, Institute of Biomedical Research (II-B Sant Pau), CIBER CV, UAB, Barcelona, Spain
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7
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Montano A, Halicek M, Collier V, Reese B. Critical Left Subclavian Artery Stenosis With Retrograde Vertebral Flow: A Case Report and Literature Review. Cureus 2023; 15:e51027. [PMID: 38264376 PMCID: PMC10804909 DOI: 10.7759/cureus.51027] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/25/2024] Open
Abstract
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.
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Affiliation(s)
- Andreas Montano
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | | | - Victor Collier
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Brooke Reese
- Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, USA
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Wei L, Gao X, Tong Z, Cui S, Guo L, Gu Y. Outcomes of covered stents versus bare-metal stents for subclavian artery occlusive disease. Front Cardiovasc Med 2023; 10:1194043. [PMID: 37485269 PMCID: PMC10361563 DOI: 10.3389/fcvm.2023.1194043] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
Objective To compare the clinical efficacy of covered stents and bare-metal stents in the endovascular treatment of subclavian artery occlusive disease. Methods Between January 2014 and December 2020, 161 patients (112 males) underwent stenting of left subclavian arteries; CSs were implanted in 55 patients (34.2%) and BMSs in 106 (65.8%). Thirty-day outcomes, mid-term patency, and follow-up results were analyzed with Kaplan-Meier curves. Relevant clinical, anatomical, and procedural factors were evaluated for their association with patency in the two groups using Cox proportional hazards regression. Results Mean follow-up was 45 ± 18 months. The primary patency was 93.8% (95% CI, 81.9%-98.0%) in the covered stent group and 73.7% (95% CI, 63.2%-81.6%; P = 0.010) in the bare-metal stent group. The primary patency in the total occlusion subcategory was significant in favor of CS (93.3%, 95% CI, 61.26%-99.0%) compared with BMS (42.3%, 95% CI, 22.9%-60.5%; P = 0.005). Cox proportional hazards regression indicated that the use of BMSs [hazard ratio (HR), 4.90; 95% CI, 1.47-16.31; P = 0.010] and total occlusive lesions (HR, 7.03; 95% CI, 3.02-16.34; P < 0.001) were negative predictors of patency, and the vessel diameter (HR, 3.17; 95% CI, 1.04-9.71; P = 0.043)) was a positive predictor of patency. Conclusion Compared with bare stents, covered stents have a higher midterm primary patency in the treatment of subclavian artery occlusive disease.
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Nakata J, Stahlfeld KR, Simone ST. Subclavian steal syndrome in a right aortic arch with aberrant left subclavian artery atresia. SAGE Open Med Case Rep 2023; 11:2050313X231179305. [PMID: 37342424 PMCID: PMC10278403 DOI: 10.1177/2050313x231179305] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/12/2023] [Indexed: 06/22/2023] Open
Abstract
Congenital aortic arch anomalies are an uncommon diagnosis resulting from embryologic malformations during the fourth to eighth week of gestation. Asymptomatic variants frequently are overlooked in the perinatal period and diagnosed incidentally during adulthood. Symptomatic variants can present with steal syndrome or dysphagia lusoria. The right aortic arch is a rare anomaly that is usually associated with other congenital anomalies but can occur in isolation. The most common types of right aortic arches are mirror image branching or an aberrant left subclavian artery. Aortic arch anomalies are important to recognize as they may have important implications in management. We present a 74-year-old female with a right aortic arch and aberrant left subclavian artery that was discovered after a fall. An extensive evaluation and work-up revealed symptoms consistent with subclavian steal syndrome that resolved following a carotid-axillary bypass. Subclavian steal secondary to a right aortic arch is extremely rare. This report reviews the current literature of a right aortic arch with an aberrant left subclavian artery presenting as a subclavian steal syndrome.
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Affiliation(s)
- Jonathan Nakata
- Jonathan Nakata, Department of General Surgery, UPMC Mercy, 1400 Locust Street, Pittsburgh, PA 15219, USA.
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Torere BE, Aiwuyo HO, Rash M, Gerlach G, Russell N, Robinson Dolye A. Subclavian Steal Syndrome as the Initial Presentation of Takayasu's Vasculitis in a Young Caucasian Female. Cureus 2023; 15:e37940. [PMID: 37220439 PMCID: PMC10200268 DOI: 10.7759/cureus.37940] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
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.
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Affiliation(s)
| | - Henry O Aiwuyo
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Max Rash
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
| | - Gene Gerlach
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
| | - Noah Russell
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
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Cai J, Xie C, Wang X. Subclavian steal syndrome associated with right aortic arch: A case report. Front Surg 2023; 9:1063224. [PMID: 36684375 PMCID: PMC9852614 DOI: 10.3389/fsurg.2022.1063224] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/21/2022] [Indexed: 01/07/2023] Open
Abstract
The right aortic arch (RAA) is a rare congenital vascular variant disease. We reported a case of subclavian steal syndrome associated with RAA. The primary clinical symptoms were vertigo and ischemic symptoms of the left upper extremity. We diagnosed the condition using aortic computed tomography angiography and digital subtraction angiography. The patient underwent carotid-subclavian bypass surgery.
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Affiliation(s)
- Jing Cai
- Department of General Practice, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xianwei Wang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China,Correspondence: Xianwei Wang Email
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12
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Muacevic A, Adler JR, Kaur P, Das DD, Kondapalli M. Recurrent Subclavian Steal Syndrome: A Novel Case of Vasculopathy. Cureus 2023; 15:e33310. [PMID: 36741643 PMCID: PMC9894333 DOI: 10.7759/cureus.33310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
Subclavian steal syndrome (SSS) refers to the phenomenon of retrograde flow in an ipsilateral branch of the subclavian artery due to hemodynamically significant stenosis or occlusion of the ipsilateral proximal subclavian artery. While SSS is usually asymptomatic, it can manifest as vertebrobasilar insufficiency (VBI), ischemia of the affected extremity, or cardiac angina when an internal mammary artery (IMA) is used as a bypass graft. The underlying etiology is most often atherosclerosis but can include Takayasu arteritis, thoracic outlet syndrome, cervical rib, and stenosis secondary to surgical repair of aortic coarctation or tetralogy of Fallot. There are several case reports describing unique presentations of SSS as well as limited reports of double SSS, where the brachiocephalic steno-occlusive disease causes flow reversal in both the ipsilateral vertebral and carotid arteries. We report herein the first documented case, to our knowledge, of a patient with SSS previously treated with left subclavian artery stenting and left common carotid-subclavian bypass who developed recurrent SSS in conjunction with orthostatic cerebral hypoperfusion syndrome (OCHOS) secondary to severe vasculopathy. She presented with recurrent, paroxysmal vertigo and near-syncope associated with left upper extremity paresthesias that would only abate with sitting in the context of left subclavian artery stent restenosis and occlusion of her left common carotid-subclavian bypass graft. Interestingly, her initial presentation entailed retrograde flow from the left vertebral artery to the left subclavian artery, classic for SSS, but recurrence of her SSS involved retrograde flow from the left common carotid artery to the left subclavian artery, a phenomenon which has also not been described in the literature to our knowledge. As her symptoms of VBI appeared to be triggered by standing and not left arm movement, they were considered to be primarily secondary to OCHOS. Consequently, her primary treatment was to increase salt and fluid intake and thus increase intravascular volume for improved cerebral perfusion as she was not deemed to be a suitable candidate for regrafting of the left subclavian artery.
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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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14
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Takajo D, Blake J, Aggarwal S. Subclavian Steal Phenomenon Associated With Vascular Ring in an Infant Who Had a Prenatally Diagnosed Right Aortic Arch With an Atretic Aberrant Left Subclavian Artery. Tex Heart Inst J 2022; 49:487182. [PMID: 36191603 PMCID: PMC9632374 DOI: 10.14503/thij-20-7415] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Vascular ring is a rare congenital anomaly in which the abnormal origin of the aorta or its branches and pulmonary arteries leads to encircling and compression of the trachea and esophagus. A right aortic arch (RAA) with an aberrant left subclavian artery is one of the most common forms of vascular ring. Here, we report a case of a prenatally diagnosed vascular ring resulting from an RAA with an aberrant left subclavian artery. When the infant was 7 months of age, the development of noisy breathing prompted further evaluation with cardiac magnetic resonance imaging that showed an atretic left subclavian artery associated with collateral retrograde flow from the left vertebral artery to the distal portion of the subclavian artery. Our findings indicate that an untreated RAA with an aberrant left subclavian artery may be associated with an increased risk of developing subclavian artery steal syndrome.
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Affiliation(s)
- Daiji Takajo
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Jennifer Blake
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Sanjeev Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
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15
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Ballout AA, Schneider JR, Patel AV, Patsalides A. Subclavian steal phenomena in right-sided aortic arch with isolated left subclavian artery as demonstrated by quantitative-MRA. Neuroradiol J 2022; 35:539-540. [PMID: 35220833 PMCID: PMC9437495 DOI: 10.1177/19714009211059116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Right-sided aortic arch with an isolated left subclavian artery is a very rare congenital anatomical variant that can lead to subclavian steal syndrome. We present a case of an asymptomatic patient who was incidentally found to have this variant on CT angiography with QMRA evidence of retrograde flow in the left vertebral artery consistent with subclavian steal phenomena. Since patients often remain asymptomatic until their compensatory mechanisms become compromised later in life, serial monitoring using non-invasive hemodynamic studies such as QMRA may guide treatment.
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Affiliation(s)
- Ahmad A Ballout
- Departments of Neurology, 5799Northwell Health, and 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Julia R Schneider
- Departments of Neurology, 5799Northwell Health, and 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Anand V Patel
- Department of Neurology, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Athos Patsalides
- Departments of Neurological Surgery, 24945North Shore University Hospital, Manhasset, NY, USA
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16
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George JM, Cooke PV, Ilonzo N, Tadros RO, Grossi RJ. Management of Innominate Artery Occlusion With Severe Left Common Carotid Artery Stenosis. Cureus 2021; 13:e19592. [PMID: 34926061 PMCID: PMC8671066 DOI: 10.7759/cureus.19592] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 11/27/2022] Open
Abstract
Innominate artery occlusion is a rare entity, particularly when coupled with severe left common carotid artery stenosis. Innominate artery disease may present with varying degrees of symptomatology and can place patients at risk for both posterior fossa and hemispheric ischemic events. We present a symptomatic case of innominate artery occlusion with severe left common carotid disease. We reviewed the literature and current options for the treatment of innominate artery disease. The patient underwent successful hybrid repair with left carotid artery retrograde stenting and left carotid artery to right carotid artery bypass. She has been symptom and re-intervention free during her one-year follow-up. We describe a successful hybrid repair of symptomatic innominate artery occlusion with concomitant severe left carotid artery stenosis in a patient with a prohibitive open thoracic surgical risk.
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Affiliation(s)
- Justin M George
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Peter V Cooke
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Nicole Ilonzo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Weill Cornell, New York, USA
| | - Rami O Tadros
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert J Grossi
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
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17
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Abstract
The definition of subclavian steal is subclavian artery occlusion or hemodynamically significant stenosis proximal to the origin of the vertebral artery that results in lower pressure in the distal subclavian artery. Although subclavian steal can often remain asymptomatic, if ignored, it can cause syncope or neurological deficits. Detailed routine evaluation of blood pressure and careful physical examination, simultaneously on both sides of patients at high vascular risk (such as those with hypertension, dyslipidemia, and diabetes), can assist in the early detection. Herein, we report the case of an 82-year-old male patient with steal syndrome, who had no subjective symptoms despite severe stenosis of the subclavian artery, with a marked left-right difference in blood pressure.
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Affiliation(s)
- Yu Amano
- Faculty of Medicine, Shimane University, Izumo, JPN
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Izumo, JPN
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18
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Bajko Z, Motataianu A, Stoian A, Barcutean L, Andone S, Maier S, Drăghici IA, Cioban A, Balasa R. Prevalence and Clinical Characteristics of Subclavian Steal Phenomenon/Syndrome in Patients with Acute Ischemic Stroke. J Clin Med 2021; 10:5237. [PMID: 34830519 DOI: 10.3390/jcm10225237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 12/21/2022] Open
Abstract
There are no published clinical studies regarding the prevalence of subclavian steal among acute ischemic stroke patients. The aim of this study was to evaluate the prevalence and clinical significance of subclavian steal among a large number of consecutive ischemic stroke patients. Materials and methods: We reviewed the medical records of 2192 consecutive cases of acute ischemic stroke at a tertiary neurology clinic in Targu Mures, Romania, between 2018 and 2020. In total, 47 patients (2.2%) were diagnosed with subclavian steal phenomenon/syndrome. Results: Stroke patients with associated steal phenomenon were significantly younger (64.2 ± 11.1 versus 70.2 ± 12.8, p = 0.005) and predominantly male (68.1%). From among the 47 patients with subclavian steal phenomenon, nine (19.1%) presented stroke symptomatology in the vertebrobasilar territory. Overall, 83.3% of the stroke patients with associated steal phenomenon presented cerebral infarction and 16.7% presented TIA. There was no difference between groups regarding the affected vascular territory (VB versus carotid). Large artery atherosclerosis was more frequent in the stroke group with associated steal phenomenon (81.3% versus 43.5%, p = 0.0033). The NIHSS score at admission was higher in the patient group with associated steal phenomenon, but there was no difference in mRS at discharge. Associated carotid artery occlusion was more frequent in the stroke group with steal phenomenon (p < 0.01). Smoking and peripheral arteriopathy were more frequent in the patient group with associated steal phenomenon. Of the nine symptomatic patients, five underwent revascularization treatment. Conclusions: The prevalence of subclavian steal phenomenon among acute ischemic stroke patients was not higher than in other cohorts with heterogenous peripheral vascular pathologies. Similar to the general population, in acute ischemic stroke patients, the associated subclavian steal behaved like a benign hemodynamical condition, without severe consequences.
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19
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Abstract
Mortality from penetrating traumas involving the subclavian vessels can be as high as 60% in pre-hospital settings. Operating room mortality is in the range of 5-30%. This paper presents a case in which a strategy for damage control was employed for a patient with an injury to the origin of the left subclavian artery, using subclavian ligation, with no need for any other intervention, and maintaining viability of the left upper limb via collateral circulation. The authors also review surgical approaches and treatment strategies with a focus on damage control in subclavian vessel injuries.
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Affiliation(s)
- Adenauer Marinho de Oliveira Góes
- Cirurgia Vascular, Hospital Metropolitano de Urgência e Emergência - HMUE, Ananindeua, PA, Brasil.,Faculdade de Medicina, Universidade Federal do Pará - UFPA, Belém, PA, Brasil
| | - Mariana Pereira Maurity
- Cirurgia Geral, Hospital Metropolitano de Urgência e Emergência - HMUE, Ananindeua, PA, Brasil
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20
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Coles M, Mareddy C, Arora V. Don't Ignore That Chest Pain: Positionally Dependent Coronary Subclavian Steal Syndrome. J Invasive Cardiol 2021; 33:E145. [PMID: 33531448] [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] [Indexed: 06/12/2023]
Abstract
Coronary subclavian steal syndrome (CSSS) is a complication incurred after coronary artery bypass grafting (CABG), characterized by retrograde blood flow through the left internal mammary artery (LIMA) graft to the left subclavian artery (SCA) distal to a SCA stenosis, thereby compromising myocardial perfusion from the LIMA despite its patency. We present a 40-year-old female with a history of triple-vessel CABG who presented with crescendo angina, notably when elevating her arms above her head. Atypical angina related to arm activity following successful LIMA bypass should prompt angiography directed to the left SCA, as well as to the LIMA graft. Typically, cases of CSSS are claudication dependent and not positionally related. This suggests a two-pronged pathophysiological mechanism of both demand ischemia and mechanical obstruction, which is not well described in previous literature.
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Affiliation(s)
- Michael Coles
- Department of Cardiology, Augusta University Medical Center, 1120 15th Street, Augusta, GA 30912 USA.
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21
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Çivilibal Tang N, Çelik Alaçam N, Bornaun H, Erdem A, Yılmaz Güleç E. Left subclavian artery originating from left pulmonary artery in DiGeorge syndrome. Turk Gogus Kalp Damar Cerrahisi Derg 2020; 28:691-4. [PMID: 33403146 DOI: 10.5606/tgkdc.dergisi.2020.19613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/03/2020] [Indexed: 11/21/2022]
Abstract
Left subclavian artery originating from the left pulmonary artery is a rare aortic arch anomaly. Herein, we, for the first time in Turkey, present a case of left subclavian artery originating from the left pulmonary artery via ductus arteriosus in DiGeorge syndrome and causing subclavian steal syndrome.
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22
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Alemzadeh-Ansari MJ, Sarreshtehdari A, Abdi S, Moosavi J, Shafe O, Sadeghipour P, Pouraliakbar H, Mohebbi B. Acute coronary syndrome following arteriovenous fistula creation in a post CABG patient: A steal phenomenon from coronary artery to subclavian artery. Semin Dial 2020; 34:89-93. [PMID: 33222284 DOI: 10.1111/sdi.12933] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 70-year-old man with a history of coronary artery bypass grafting 15 years back and arteriovenous (AV) fistula creation in the left arm 1 month back presented with acute coronary syndrome (ACS). He had not received dialysis before his referral. We felt the most likely etiology for these complaints was increased cardiac oxygen demand from an increased cardiac output related to the newly formed left AV fistula. Coronary angiography was done to detect any significant stenosis in the native or grafted vessels. This revealed that the left subclavian artery was totally occluded in the ostioproximal segment and the coronary arteries did not have occlusions to explain the ACS setting. CT angiography confirmed the angiographic findings of the totally occluded left subclavian artery followed by a well-developed and patent left internal mammary artery to left anterior descending artery. This led to the consideration of a steal syndrome from the coronary artery by the subclavian artery distal to the occlusion. A successful percutaneous endovascular intervention on the left subclavian artery occlusion was performed. Subsequently, the patient became asymptomatic and experienced a dramatic increase in left ventricular ejection fraction.
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Affiliation(s)
- Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sarreshtehdari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Shafe
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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23
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Fakih R, Dandapat S, Mendez-Ruiz A, Mendez AA, Farooqui M, Zevallos C, Quispe Orozco D, Hasan D, Rossen J, Samaniego EA, Derdeyn C, Ortega-Gutierrez S. Combined Transradial and Transfemoral Approach With Ostial Vertebral Balloon Protection for the Treatment of Patients With Subclavian Steal Syndrome. Front Neurol 2020; 11:576383. [PMID: 33193028 PMCID: PMC7642489 DOI: 10.3389/fneur.2020.576383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Patients with an obstructive subclavian artery (SA) may exhibit symptoms of vertebrobasilar insufficiency known as subclavian steal syndrome (SSS). Endovascular treatment with stent assisted percutaneous transluminal angioplasty (SAPTA) demonstrates significantly lower percentage of intraoperative and postoperative complications in comparison with open surgery. There is a 1–5% risk of distal intracranial embolization through the ipsilateral vertebral artery (VA) during SAPTA. Objective: To assess the safety and feasibility of a novel technique for distal embolic protection using balloon catheters during SA revascularization with a dual transfemoral and transradial access. Methods: We describe a case series of patients with SSS who underwent SAPTA due to severe stenosis or occlusion of the SA using a combined anterograde/retrograde approach. Transfemoral access to SA was obtained using large bore guide sheaths. Ipsilateral transradial access was obtained using intermediate bore catheters. A Scepter XC balloon catheter was introduced through the transradial intermediate catheter into the ipsilateral VA at the ostium during SAPTA for distal embolic protection. Results: A total of eight patients with SSS underwent subclavian SAPTA. Four patients had the combined anterograde/retrograde approach. Successful revascularization was achieved in three of them. It was difficult to create a channel in the fourth unsuccessful case due to heavily calcified plaque burden. No peri-operative ischemic events were identified. On follow-up, we demonstrated patency of the stents with resolution of symptoms and without any adverse events. Conclusion: Subclavian stenting using a combined transradial and transfemoral access with compliant balloon catheters at the vertebral ostium for prevention of distal emboli may represent an alternative therapeutic approach for the treatment of SA stenosis and occlusions.
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Affiliation(s)
- Rami Fakih
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Alan Mendez-Ruiz
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Aldo A Mendez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Cynthia Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Darko Quispe Orozco
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - David Hasan
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - James Rossen
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Internal Medicine-Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Colin Derdeyn
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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24
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Niu G, Yan Z, Zhang B, Yang M. Endovascular Treatment of Chronic Total Occlusion in the Subclavian Artery: A Review of 23 Cases. Front Neurol 2020; 11:264. [PMID: 32390926 PMCID: PMC7193770 DOI: 10.3389/fneur.2020.00264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/20/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives and Background: To review technical details and long-term outcomes of endovascular treatment of chronic total occlusion (CTO) of the subclavian artery. Methods: From January 2010 to May 2017, 23 patients (17 male; median age, 65 years) underwent endovascular treatment for CTO of the subclavian artery. All lesions had been diagnosed by duplex scanning or computed tomography angiography before treatment. Sixteen (70.0%) patients had symptoms of vertebrobasilar insufficiency, 6 (26.1%) patients had symptoms of arm ischemia, and 2 (8.7%) patients were asymptomatic. Duplex scanning revealed that 16 patients had grade 3 and 7 patients had grade 2 steal blood flow. After recanalization, lesions were treated by stenting. Patients were followed up at 1, 3, 6, and 12 months after endovascular treatment, and annually thereafter. Results: The overall technical success rate was 91.3% (21/23). The successful recanalization rate of antegrade and retrograde approaches were 68.2% (15/22) and 75.0% (6/8), respectively. The rate of clinical symptom remission was 95.2% (20/21) after treatment. No perioperative death or permanent neurological deficits were observed. One patient had arterial dissection treated by covered stent. The estimate cumulative primary and secondary patency rates at 5 years were 74.6 and 78.8%, respectively. Conclusion: Endovascular treatment is a feasible and safe treatment for CTO lesions of the subclavian artery.
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Affiliation(s)
- Guochen Niu
- Interventional Radiology and Vascular Surgery Department, Peking University First Hospital, Beijing, China
| | - Ziguang Yan
- Interventional Radiology and Vascular Surgery Department, Peking University First Hospital, Beijing, China
| | - Bihui Zhang
- Interventional Radiology and Vascular Surgery Department, Peking University First Hospital, Beijing, China
| | - Min Yang
- Interventional Radiology and Vascular Surgery Department, Peking University First Hospital, Beijing, China
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25
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De Roeck F, Tijskens M, Segers VFM. Coronary- subclavian steal syndrome, an easily overlooked entity in interventional cardiology. Catheter Cardiovasc Interv 2019; 96:614-619. [PMID: 31179616 DOI: 10.1002/ccd.28362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 03/15/2019] [Accepted: 05/22/2019] [Indexed: 11/10/2022]
Abstract
Coronary-subclavian steal syndrome (CSSS) is a severe complication of coronary artery bypass graft (CABG) surgery with internal mammary artery grafting. It is caused by functional graft failure due to a hemodynamically significant proximal subclavian artery stenosis. In this manuscript, we provide a comprehensive review of literature and we report a series of five consecutive CSSS cases. This case series illustrates the variable clinical presentation, thereby emphasizing the importance of raised awareness concerning this pathology in CABG patients.
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Affiliation(s)
- Frederic De Roeck
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Maxime Tijskens
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Vincent F M Segers
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium.,Laboratory of Physiopharmacology, University of Antwerp, Wilrijk, Belgium
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26
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Krasucki DJ. Beach Chair Position in a Patient With Subclavian Steal Syndrome and Axillary Lymph Node Dissection: A Case Report. AANA J 2019; 87:185-191. [PMID: 31584395] [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] [Indexed: 06/10/2023]
Abstract
A patient presented for elective shoulder arthroscopy who had subclavian steal syndrome. The patient's history included bilateral mastectomy with unilateral lymph node dissection, limiting noninvasive oscillometric blood pressure monitoring on the nonoperative side. This history, combined with the necessary surgical positioning and calf blood pressure monitoring, raised the concern of decreased cerebral perfusion during a general anesthetic in the beach chair position. This report describes the management of this particular case, then reviews the relevant literature regarding cardiovascular and cerebral perfusion monitoring.
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27
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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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Lachmann M, Pfeiffer D, Ibrahim T. An Unexpected Origin of Fluctuating Pulsatile Tinnitus. JACC Cardiovasc Interv 2018; 11:e189-e190. [PMID: 30448169 DOI: 10.1016/j.jcin.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Mark Lachmann
- Medizinische Klinik 1, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
| | - Daniela Pfeiffer
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- Medizinische Klinik 1, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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Lubert AM, Cotts TB, Henke PK. Symptomatic Subclavian Steal During Pregnancy in a Woman Status Post Coarctation Repair in Infancy. World J Pediatr Congenit Heart Surg 2018; 11:NP172-NP175. [PMID: 30200813 DOI: 10.1177/2150135118783638] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 24-year-old woman with a history of coarctation repair by subclavian flap aortoplasty presented at 15 weeks' gestation with transient episodes of vision loss. She was diagnosed with subclavian steal syndrome and underwent left carotid artery to subclavian artery bypass at 17 weeks' gestation. She has had no recurrence of symptoms at ten months of postoperative follow-up. Despite the anatomic substrate for subclavian steal in patients with this type of surgical repair, neurologic symptoms are uncommon. It is possible that the pregnancy-induced fall in systemic vascular resistance triggered symptoms in this previously asymptomatic patient.
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Affiliation(s)
- Adam M Lubert
- Division of Pediatric Cardiology, Department of Pediatrics, Adult Congenital Heart Program, University of Michigan, Ann Arbor, MI, USA
| | - Timothy B Cotts
- Division of Pediatric Cardiology, Department of Pediatrics, Adult Congenital Heart Program, University of Michigan, Ann Arbor, MI, USA
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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De Bruyn D, Van Aken E, Herman K. A rare case of concomitant sicca keratopathy and ipsilateral central facial palsy in Wallenberg's dorsolateral medullary syndrome. GMS Ophthalmol Cases 2017; 7:Doc08. [PMID: 28293537 PMCID: PMC5343209 DOI: 10.3205/oc000059] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To describe a patient with a right-sided supranuclear facial palsy and concomitant sicca keratopathy of the right eye following right-sided dorsolateral medullary infarction. Methods: Our patient underwent a complete ophthalmologic and neurologic examination including biomicroscopy, fundus examination, cranial nerve examination, Shirmer I test, and magnetic resonance imaging of the brain. Results: A 61-year-old woman presented in emergency with a central facial nerve palsy on the right side and truncal ataxia. Neurologic assessment revealed a concurrent dysphagia, dysarthria, hypoesthesia of the right face, and weakness of the right upper limb. Magnetic resonance imaging of the brain showed an old left-sided cerebellar infarction, but a recent ischemic infarction at the level of the right dorsolateral medulla oblongata was the cause of our patient’s current problems. One month after diagnosis of the right-sided dorsolateral medullary syndrome, there were complaints of ocular irritation and a diminished visual acuity in the right eye. Biomicroscopy showed a sicca keratopathy with nearly complete absence of tear secretion on the Shirmer I test, but with normal eye closure and preserved corneal reflexes and sensitivity. Conclusion: A dorsolateral medullary syndrome can have a variable expression in symptomatology. Our case is special because of the combination of an ipsilateral supranuclear facial palsy with normal upper facial muscle function together with an ipsilateral sicca keratopathy as a result of a nearly absent tear secretion. We hypothesized that the mechanism underlying the patient’s sicca keratopathy ipsilateral to the supranuclear facial palsy involved the superior salivatory nucleus, which is situated in the caudal pons inferiorly of the motor facial nucleus and is most probably affected by a superior extension of the infarcted area in the right medulla oblongata.
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Affiliation(s)
- Deborah De Bruyn
- Dpt. Ophthalmology, Ghent University Hospital & Ghent University, Ghent, Belgium
| | - Elisabeth Van Aken
- Dpt. Ophthalmology, Ghent University Hospital & Ghent University, Ghent, Belgium; Dpt. Ophthalmology, Sint-Elisabeth Hospital, Zottegem, Belgium
| | - Kristien Herman
- Dpt. Ophthalmology, Sint-Elisabeth Hospital, Zottegem, Belgium
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Karpenko A, Starodubtsev V, Ignatenko P, Gostev A. Endovascular Treatment of the Subclavian Artery Steno-Occlusive Disease. J Stroke Cerebrovasc Dis 2016; 26:87-93. [PMID: 27743924 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of our study was to compare immediate and long-term results of endovascular interventions for the treatment of steno-occlusive disease of subclavian arteries (SAs) depending on the length of lesion. MATERIALS AND METHODS Between 2010 and 2013, we performed 245 endovascular procedures to treat patients with atherosclerotic steno-occlusive disease of SAs. All patients were examined and subdivided according to the received results into 2 groups: 125 patients with stenosis of SA were included in the first group and 120 patients with occlusion of SA were included in the second group. The patients were then followed up at 6, 12, 24, 36, and 48 months after endovascular interventions. Follow-up visits contained symptomatic evaluation, clinical assessment with physical examination, complete neurological evaluation, and serial color Doppler ultrasonography. RESULT Transitory ischemic attacks in the vertebrobasilar system were intraoperatively developed by 1 patient from the first group (.8%) and 3 patients from the second group (2.5%). Reinterventions in the long-term period were carried out in 9 (7.2%) cases in the first group and 12 (10%) cases in the second group (P = .43). The cumulative primary stent patency at 4 years was 89.8% in the first group and 87% in the second group (P = .4). CONCLUSIONS In the case of SA occlusion on the first stage, it is expedient to carry out endovascular recanalization followed by stenting. Our study revealed an increased risk of stent thrombosis or in-stent restenosis in patients with stents >40 mm.
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Affiliation(s)
- Andrey Karpenko
- Academician E.N. Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Ministry for Public Health Care Russian Federation, Novosibirsk, Russian Federation
| | - Vladimir Starodubtsev
- Academician E.N. Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Ministry for Public Health Care Russian Federation, Novosibirsk, Russian Federation.
| | - Pavel Ignatenko
- Academician E.N. Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Ministry for Public Health Care Russian Federation, Novosibirsk, Russian Federation
| | - Alexander Gostev
- Academician E.N. Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Ministry for Public Health Care Russian Federation, Novosibirsk, Russian Federation
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Satti SR, Golwala SN, Vance AZ, Tuerff SN. Subclavian steal: Endovascular treatment of total occlusions of the subclavian artery using a retrograde transradial subintimal approach. Interv Neuroradiol 2016; 22:340-8. [PMID: 26861024 DOI: 10.1177/1591019916628321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/01/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION In symptomatic subclavian steal syndrome, endovascular treatment is the first line of therapy prior to extra-anatomic surgical bypass procedures. Subintimal recanalization has been well described in the literature for the coronary arteries, and more recently, in the lower extremities. By modifying this approach, we present a unique retrograde technique using a heavy tip microwire to perform controlled subintimal dissection. METHODS We present two cases of symptomatic subclavian steal related to chronic total occlusion of the left subclavian artery and right innominate artery, respectively. Standard crossing techniques were unsuccessful. Commonly at this point, the procedures would be aborted and open surgical intervention would have to be pursued. In our cases, retrograde access was easily achieved via an ipsilateral retrograde radial artery, using controlled subintimal dissection and a heavy-tipped wire. RESULTS We were able to easily achieve recanalization in both attempted cases of chronic total occlusion of the subclavian and innominate artery, using a retrograde radial subintimal approach. Subsequent stent-supported angioplasty resulted in complete revascularization. No major complications were encountered during the procedures; however, one patient did develop thromboembolic stroke secondary to platelet aggregation to the stent graft, 9 days post-procedure. CONCLUSIONS Endovascular treatment is considered the first-line intervention in medically refractory patients with symptomatic subclavian steal syndrome. In the setting of chronic total occlusions, a retrograde radial subintimal approach using a heavy tip wire for controlled subintimal dissection is a novel technique that may be considered when standard approaches and wires have failed.
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Fu XY, Zhang ZD, Liang K, Shi ST, Wang GQ, Zhang KW, Li K, Li WX, Li TX, Zhai ST. Subclavian steal syndrome decreases neurogenesis in the cerebellar cortex and affects cognitive function in rabbits. Exp Ther Med 2015; 10:1455-1459. [PMID: 26622506 DOI: 10.3892/etm.2015.2670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 07/07/2015] [Indexed: 01/26/2023] Open
Abstract
Subclavian steal syndrome (SSS) is a condition characterized by a steno-occlusive impairment of the proximal subclavian artery. The majority of patients with SSS are asymptomatic, while symptomatic patients present with neurological symptoms. SSS is a risk factor for cerebral ischemia, which reacts badly upon cognitive function; however, it remains unknown whether SSS is able to cause progressive cognitive impairment. In the present study, the potential effects of SSS on cognitive function were investigated using atherosclerotic rabbits as a model of SSS. A total of 48 male New Zealand rabbits were divided into the control, sham and SSS groups. The results of eyeblink experiments indicated no significant differences among the three groups; however, SSS did appear to exert a negative impact on neurogenesis in the cerebellar cortex. In order to further clarify the mechanisms underlying this SSS-mediated reduction in cell proliferation, the energy metabolism, immune function and oxidative stress statuses were evaluated by determining the levels of adenosine triphosphate (ATP), adenosine, interleukin (IL)-1β, IL-6, malondialdehyde, 8-hydroxy-2'-deoxyguanosine, CuZn-superoxide dismutase and catalase. The results showed that the levels of extracellular ATP in the cerebellar cortex had decreased, while levels of adenosine had also decreased. These findings suggest that SSS is able to inhibit neurogenesis in the cerebellar cortex by decreasing the extracellular ATP levels. Furthermore, these changes may result in an impairment of the cognition of the rabbits. The early diagnosis and treatment of SSS may, therefore, prevent or mitigate cognitive impairment in the future.
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Affiliation(s)
- Xiao-Yang Fu
- Department of Vascular and Endovascular Surgery, Henan Provincial Hospital, Zhengzhou, Henan 450003, P.R. China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Medical School, Zhengzhou, Henan 450003, P.R. China
| | - Zhi-Dong Zhang
- Department of Vascular and Endovascular Surgery, Henan Provincial Hospital, Zhengzhou, Henan 450003, P.R. China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Medical School, Zhengzhou, Henan 450003, P.R. China
| | - Kai Liang
- Department of Vascular and Endovascular Surgery, Henan Provincial Hospital, Zhengzhou, Henan 450003, P.R. China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Medical School, Zhengzhou, Henan 450003, P.R. China
| | - Shuai-Tao Shi
- Department of Vascular and Endovascular Surgery, Henan Provincial Hospital, Zhengzhou, Henan 450003, P.R. China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Medical School, Zhengzhou, Henan 450003, P.R. China
| | - Guo-Quan Wang
- Department of Vascular and Endovascular Surgery, Henan Provincial Hospital, Zhengzhou, Henan 450003, P.R. China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Medical School, Zhengzhou, Henan 450003, P.R. China
| | - Ke-Wei Zhang
- Department of Vascular and Endovascular Surgery, Henan Provincial Hospital, Zhengzhou, Henan 450003, P.R. China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Medical School, Zhengzhou, Henan 450003, P.R. China
| | - Kun Li
- Department of Vascular and Endovascular Surgery, Henan Provincial Hospital, Zhengzhou, Henan 450003, P.R. China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Medical School, Zhengzhou, Henan 450003, P.R. China
| | - Wei-Xiao Li
- Department of Vascular and Endovascular Surgery, Henan Provincial Hospital, Zhengzhou, Henan 450003, P.R. China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Medical School, Zhengzhou, Henan 450003, P.R. China
| | - Tian-Xiao Li
- Department of Vascular and Endovascular Surgery, Henan Provincial Hospital, Zhengzhou, Henan 450003, P.R. China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Medical School, Zhengzhou, Henan 450003, P.R. China
| | - Shui-Ting Zhai
- Department of Vascular and Endovascular Surgery, Henan Provincial Hospital, Zhengzhou, Henan 450003, P.R. China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Medical School, Zhengzhou, Henan 450003, P.R. China
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Yen YH, Tsou TF, Chang KW, Tsai CF, Su CH. Velocity-Encoded Phase-Contrast Magnetic Resonance Imaging for Diagnosing Severe Bilateral Subclavian Steal Syndrome with Complete Vertebral Reversal. Acta Cardiol Sin 2014; 30:337-340. [PMID: 27122808 PMCID: PMC4804997] [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] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 12/20/2013] [Indexed: 06/05/2023]
Abstract
UNLABELLED Subclavian steal syndrome (SSS) involves changes in hemodynamics secondary to proximal subclavian artery stenosis and/or occlusion where the subclavian artery "drains" the blood from the vertebral artery. It sometimes induces neuromuscular symptoms, especially in cases with bilateral involvement. We report the case of a 65-year-old symptomatic male with severe bilateral SSS with complete vertebral reversal. Doppler ultrasonography yielded inconclusive results because of a scar in the left lower neck region leading to poor acoustic windows. Subsequent magnetic resonance imaging with contrast-enhanced magnetic resonance angiography and velocity-encoded phase-contrast magnetic resonance imaging provided the vascular morphology and blood flow pattern which allowed subsequent interventions to be successfully performed. KEY WORDS Angioplasty; Phase-contrast magnetic resonance imaging; Subclavian steal syndrome.
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Affiliation(s)
- Yuan-Hung Yen
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung
- Division of Cardiology, Department of Internal Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou
| | - Teng-Fu Tsou
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kai-Wei Chang
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung
| | - Chin-Feng Tsai
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung
| | - Chun-Hung Su
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung
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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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Abstract
Syncope describes a sudden and brief transient loss of consciousness (TLOC) with postural failure due to cerebral global hypoperfusion. The term TLOC is used when the cause is either unrelated to cerebral hypoperfusion or is unknown. The most common causes of syncopal TLOC include: (1) cardiogenic syncope (cardiac arrhythmias, structural cardiac diseases, others); (2) orthostatic hypotension (due to drugs, hypovolemia, primary or secondary autonomic failure, others); (3) neurally mediated syncope (cardioinhibitory, vasodepressor, and mixed forms). Rarely neurologic disorders (such as epilepsy, transient ischemic attacks, and the subclavian steal syndrome) can lead to cerebal hypoperfusion and syncope. Nonsyncopal TLOC may be due to neurologic (epilepsy, sleep attacks, and other states with fluctuating vigilance), medical (hypoglycemia, drugs), psychiatric, or post-traumatic disorders. Basic diagnostic workup of TLOC includes a thorough history and physical examination, and a 12-lead electrocardiogram (ECG). Blood testing, electroencephalogram (EEG), magnetic resonance imaging (MRI) of the brain, echocardiography, head-up tilt test, carotid sinus massage, Holter monitoring, and loop recorders should be obtained only in specific contexts. Management strategies involve pharmacologic and nonpharmacologic interventions, and cardiac pacing.
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Affiliation(s)
- Claudio L Bassetti
- Department of Neurology, University Hospital of Bern (Inselspital), Bern, Switzerland.
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Alcocer F, David M, Goodman R, Jain SKA, David S. A forgotten vascular disease with important clinical implications. Subclavian steal syndrome. Am J Case Rep 2013; 14:58-62. [PMID: 23569564 PMCID: PMC3614262 DOI: 10.12659/ajcr.883808] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 12/19/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Subclavian Steal Syndrome (SSS) is a fascinating vascular phenomenon in which a steno-occlusive lesion of the proximal subclavian artery causes retrograde flow in the vertebral artery away from the brain stem subsequently causing vertebrobasilar insufficiency. SSS can present with a myriad of neurological and vascular signs and symptoms, but most commonly this phenomenon presents as an incidental finding in an asymptomatic patient. CASE REPORT Our patient is a 73-year-old female sent to the cardiology clinic for surgical clearance in preparation for an elective cholecystectomy. Shortness of breath was her only complaint. Review of systems was remarkable for left arm pain and blurry vision with repetitive movement. Physical examination noticeable for absence of left radial pulse. Percutaneous angiography demonstrated a totally occulted left subclavian artery with collateral circulation form the vertebrobasilar apparatus. CONCLUSIONS Atypical presentation of this unique entity represents a challenge for physicians who require a high index of suspicion to make the diagnosis. We present an atypical case with radiographical evidence of the steal syndrome, followed by an extensive literature review of the most current diagnostic methods as well as latest recommendations for treatment options and secondary prevention.
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Affiliation(s)
- Fernando Alcocer
- Providence Heart Institute, Providence Hospital and Medical Center, Wayne State University School of Medicine, Southfield, MI, U.S.A
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Osiro S, Zurada A, Gielecki J, Shoja MM, Tubbs RS, Loukas M. A review of subclavian steal syndrome with clinical correlation. Med Sci Monit 2012; 18:RA57-63. [PMID: 22534720 PMCID: PMC3560638 DOI: 10.12659/msm.882721] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 08/25/2011] [Indexed: 12/15/2022] Open
Abstract
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 attacks and/or arm claudication. Once thought to be rare, the emergence of new imaging techniques has drastically improved its diagnosis and prevalence. The syndrome, however, remains characteristically asymptomatic and solely poses no serious danger to the brain. Recent studies have shown a linear correlation between increasing arm blood pressure difference with the occurrence of symptoms. Atherosclerosis of the SA remains the most common cause. Doppler ultrasound is a useful screening tool, but the diagnosis must be confirmed by CT or MR angiography. Conservative treatment is the initial best therapy for this syndrome, with surgery reserved for refractory symptomatic cases. Percutaneous angioplasty and stenting, rather than bypass grafts of the subclavian artery, is the widely favored surgical approach. Nevertheless, large, prospective, randomized, controlled trials are needed to compare the long-term patency rates between the endovascular and open surgical techniques.
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Affiliation(s)
- Stephen Osiro
- Department of Anatomical Sciences, School of Medicine, St. George’s University, Grenada, West Indies
| | - Anna Zurada
- Department of Anatomy, Medical School Varmia and Mazuria, Olsztyn, Poland
| | - Jerzy Gielecki
- Department of Anatomy, Medical School Varmia and Mazuria, Olsztyn, Poland
| | | | - R. Shane Tubbs
- Pediatric Neurosurgery, Children’s Hospital, Birmingham, AL. U.S.A
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George’s University, Grenada, West Indies
- Department of Anatomy, Medical School Varmia and Mazuria, Olsztyn, Poland
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Van Noord BA, Lin AH, Cavendish JJ. Rates of symptom reoccurrence after endovascular therapy in subclavian artery stenosis and prevalence of subclavian artery stenosis prior to coronary artery bypass grafting. Vasc Health Risk Manag 2007; 3:759-62. [PMID: 18078028 PMCID: PMC2291321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Percutaneous transluminal angioplasty (PTA) and stenting is commonly used to treat subclavian artery stenosis (SAS). In this study, the outcomes of 43 consecutive cases, performed at one institution from October 1997 to October 2005, were analyzed. Mean stenosis was 84.41% pre-intervention and 6.83% post-intervention. Five of the procedures were angioplasty alone; 38 were angioplasty with stenting. Technical success was achieved in 42 out of 43 patients. The 30-day mortality rate was 0%. At one-month post intervention, all patients were symptom free. Ten patients redeveloped symptoms by one year. Demographic data, patient comorbidities, and indication to treat were analyzed. It was found that prior coronary intervention led to a statistically significant higher rate of symptom reoccurrence (p = 0.036). Additionally, a divergence in the rate of symptom reoccurrence based on indication to treat SAS was noted with the highest rate of symptom reoccurrence in the pre-coronary artery bypass grafting (CABG) group and the lowest rate of symptom reoccurrence in the subclavian steal syndrome (SSS) group. The coronary subclavian steal (CSS) group had an intermediate rate of symptom reoccurrence. During this time period, 1154 CABGs were performed. Flow-limiting stenosis was noted on angiography in 17 of these patients, giving pre-CABG prevalence of 1.46%.
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Psillas G, Kekes G, Constantinidis J, Triaridis S, Vital V. Subclavian steal syndrome: neurotological manifestations. Acta Otorhinolaryngol Ital 2007; 27:33-7. [PMID: 17601209 PMCID: PMC2640015] [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] [Indexed: 05/16/2023]
Abstract
The subclavian steal syndrome is characterized by a subclavian artery stenosis located proximal to the origin of the vertebral artery. In this case, the subclavian artery steals reverse-flow blood from the vertebrobasilar artery circulation to supply the arm during exertion, resulting in vertebrobasilar insufficiency. As the vertebrobasilar arterial system feeds both the peripheral and central auditory and vestibular systems, in subclavian steal syndrome, neurotological symptoms are expected because of the vertebrobasilar insufficiency. In this report, we describe three patients suffering from subclavian steal syndrome, who presented with isolated dizziness, recurrent vertigo, hearing loss and tinnitus. In two of the three cases, a positional nystagmus was detected, which was vertical in two. Abnormal saccades were documented in one, and the auditory brainstem responses were pathological in all three patients; the caloric response was reduced in only one case. Upon magnetic resonance imaging, ischaemic lesions were observed in two patients, in the brainstem and in the hemispheres, respectively. These findings suggest that the central auditory and vestibular system is more likely to be involved in the pathogenesis of neurotological symptoms in subclavian steal syndrome. Patiehts complaining of numbness of the upper arm and isolated neurotological symptoms should be thoroughly examined for subclavian steal syndrome. Furthermore, regular follow-up must be undertaken in order to prevent other neurological deficits in the vertebrobasilar arterial territory.
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Affiliation(s)
- G Psillas
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA General Hospital of Thessaloniki, Greece.
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