Assuntos
Artéria Subclávia , Síndrome do Roubo Subclávio , Humanos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/terapia , Síndrome do Roubo Subclávio/complicações , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Tórax , StentsAssuntos
Infarto do Miocárdio , Síndrome do Roubo Subclávio , Humanos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/terapia , Resultado do TratamentoRESUMO
A woman in her 70s presented to her general practitioner (GP) with a 3-month history of left upper arm pain and weakness. A significant difference in bilateral blood pressures was noted and a further history elicited coolness in her left arm without functional compromise. A CT angiography revealed variant subclavian steal syndrome with a subclavian arterial stenosis, which was proximal to both the internal mammary and thyrocervical trunk and her left vertebral artery originating from the aortic arch. She was referred to a vascular surgeon but declined surgical intervention. Her symptoms remain stable with 6-month follow-up from her GP. This case highlights the importance of considering vascular aetiologies in upper limb pain and weakness. Our case reviews the differential diagnoses of upper limb pain and weakness, consequently leading to the discussion of an interesting variant of subclavian stenosis.
Assuntos
Artéria Subclávia , Síndrome do Roubo Subclávio , Feminino , Humanos , Artéria Subclávia/diagnóstico por imagem , Síndrome do Roubo Subclávio/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem , Constrição Patológica/complicações , Aorta Torácica , Dor/complicaçõesRESUMO
Various surgical treatments are available for occlusive subclavian and common carotid artery diseases. Nevertheless, to date, when cerebral endovascular treatment is utilized, revascularization via direct surgery may be required. This study reported five symptomatic cases of revascularization for CCA and SCA occlusive and stenotic lesions that were expected to be challenging to treat with endovascular treatment. We performed subclavian artery-common carotid artery or internal carotid artery bypass using artificial blood vessels or saphenous vein grafts in five patients with subclavian steal syndrome, symptomatic common carotid artery occlusion, and severe proximal common carotid artery stenosis. In this study, good bypass patency was achieved in all five cases. Although there were no intraoperative complications, one patient had a postoperative lymphatic leak. Moreover, there was no recurrence of stroke during postoperative follow-up for an average of 2 years. Conclusively, subclavian artery-common carotid artery bypass can be an effective surgical treatment for common carotid artery occlusion, proximal common carotid artery stenosis, and subclavian artery occlusion.
Assuntos
Doenças das Artérias Carótidas , Estenose das Carótidas , Síndrome do Roubo Subclávio , Trombose , Humanos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Constrição Patológica , Artéria Carótida Primitiva/cirurgia , Artéria Carótida Interna/cirurgia , Doenças das Artérias Carótidas/cirurgia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/cirurgiaRESUMO
BACKGROUND Coronary subclavian steal syndrome (CSSS) is an uncommon condition in which a high-grade stenosis of the subclavian artery proximal to an internal mammary artery bypass graft results in retrograde blood flow of the bypass graft. This report is of CSSS in a 73-year-old woman who presented with ventricular tachycardia and angiographically confirmed subclavian artery stenosis proximal to the left internal mammary artery (LIMA) bypass graft 3 years following coronary artery bypass grafting (CABG). CASE REPORT The patient was a 73-year-old woman with a past medical history of multivessel coronary artery disease, found on preoperative evaluation. She underwent 2 vessel CABG in 2018. She was found to have ischemic cardiomyopathy, ejection fraction of 30% to 35% despite revascularization, and an implantable cardiac defibrillator (ICD). Three years following uncomplicated CABG, the patient presented with angina and sustained ventricular tachycardia; ICD therapy was unsuccessful. Ischemia was the etiology of the sustained ventricular tachycardia, and the patient underwent cardiac catheterization, demonstrating high-grade subclavian artery stenosis proximal to the LIMA bypass graft. Intervention of the 80% lesion of the native left anterior descending artery was done with placement of a 2.75×16-mm drug-eluting stent. The patient responded well to treatment, with no subsequent ventricular tachycardia on outpatient follow-up. CONCLUSIONS This report has shown that in patients who present with symptoms of acute coronary syndrome and a history of CABG involving the LIMA, the possibility of CSSS should be considered and investigated by coronary artery imaging so that diagnosis and management are not delayed.
Assuntos
Síndrome do Roubo Coronário-Subclávio , Stents Farmacológicos , Síndrome do Roubo Subclávio , Taquicardia Ventricular , Feminino , Humanos , Idoso , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/terapia , Síndrome do Roubo Coronário-Subclávio/diagnóstico por imagem , Síndrome do Roubo Coronário-Subclávio/complicações , Stents Farmacológicos/efeitos adversos , Ponte de Artéria CoronáriaRESUMO
BACKGROUND: The prevalence of subclavian steal (defined as retrograde/bidirectional vertebral artery flow) in the general population and in patients undergoing cerebrovascular duplex ultrasound (CDUS) examinations is variable. This is the largest study to date to analyze the incidence of duplex-suggested subclavian steal in 5615 CDUS examinations over a 1-year period and to examine its clinical implications. PATIENT POPULATION AND METHODS: All consecutive CDUS examinations performed over a 1-year period were analyzed for the presence of subclavian steal. Indications of testing, presence of posterior cerebral circulation/subclavian steal symptoms, and any interventions for subclavian steal were analyzed. RESULTS: A total of 171 of 5615 (3.1%) CDUS examinations were found to have subclavian steal (duplex-suggested). One hundred seventeen (2.1%) had retrograde flow and 54 (1%) had bidirectional flow. Of 171, 104 (60.8%) were left sided. Indications for CDUS were post-carotid endarterectomy/carotid artery stenting surveillance in 39 patients (22.8%), surveillance for progression of carotid stenosis in 76 patients (44.4%), transient ischemic attack/stroke in 26 patients (15%), asymptomatic screening/carotid bruit in 18 patients (10.5%), and isolated posterior cerebral circulation symptoms in 12 patients (7%). A total of 63% patients had associated >50% carotid stenosis. The mean arm Doppler pressure gradient was 32.2 mm Hg for asymptomatic patients vs 37 mm Hg for patients with posterior circulation symptoms (P = .3254). There were significant differences between the mean systolic arm pressure for patients with retrograde vs antegrade vs bidirectional flow (105 mm Hg vs 146 mm Hg vs 134 mm Hg, respectively, P < .0001). All patients with retrograde flow had >50% subclavian stenosis or occlusion (100 of 117 had subtotal/total occlusion) except for one patient. Meanwhile, 52 of 54 patients with bidirectional flow had >50% subclavian stenosis (6 of 54 with subtotal/total occlusion), whereas two patients were normal/<50% stenosis (P < .0001). Overall, 26 of 171 patients (15.2%) had interventions for disabling symptoms. Eleven of 26 of all interventions were for disabling arm claudication, and only 10 of 171 patients (5.8%) were intervened for disabling posterior circulation symptoms with complete resolution of symptoms in all except one. At a late follow-up with a mean of 18 months (range: 1-37 months), there was no late major stroke with only two lacunar infarcts (not subclavian steal related). There were also seven late deaths, none stroke related. CONCLUSIONS: The incidence of subclavian steal in patients who undergo CDUS is relatively rare. Most of these patients are asymptomatic and can be treated conservatively, and only a few may need intervention for disabling symptoms with good symptom resolution.
Assuntos
Estenose das Carótidas , Acidente Vascular Cerebral , Síndrome do Roubo Subclávio , Humanos , Artéria Vertebral/diagnóstico por imagem , Estenose das Carótidas/complicações , Constrição Patológica/complicações , Stents/efeitos adversos , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/terapia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologiaRESUMO
Thoracic endovascular aortic repair (TEVAR) is currently the treatment of choice for thoracic aortic disease. In select cases, the TEVAR stent must occlude the left subclavian artery. This is usually well tolerated, but the subclavian steal syndrome (SCSS) may occur. Vertebrobasilar insufficiency can cause headaches, but reports of headache as the only symptom of SCSS are very rare. Thus, this may be under-recognised. To increase the awareness of this complication we describe the course of a patient who developed chronic intermittent headaches after intentional occlusion of the left subclavian artery with a TEVAR stent. Revascularisation may be required to prevent adverse neurological outcomes from SCSS. Some authors recommend prophylactic revascularisation whenever the left subclavian artery is sacrificed during TEVAR. However, transposition or bypass of this artery is not without risk and mild symptoms, such as secondary headache, can be fully controlled with conservative measures that reduce steal pathophysiology.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Síndrome do Roubo Subclávio , Dissecção Aórtica/complicações , Aneurisma da Aorta Torácica/complicações , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Cefaleia/etiologia , Cefaleia/cirurgia , Humanos , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/cirurgiaRESUMO
The occlusion of the innominate artery caused a significant decrease in the distal end of the right subclavian artery and the right common carotid artery, internal carotid artery, and external carotid artery (ECA). Due to the different pressure and the abundant communicating arteries between the ECA and the bilateral vertebral artery (VA), different paths of blood steal in the anterior and posterior circulation occurred.
Assuntos
Tronco Braquiocefálico , Síndrome do Roubo Subclávio , Tronco Braquiocefálico/diagnóstico por imagem , Artéria Carótida Externa , Hemodinâmica , Humanos , Artéria Subclávia/diagnóstico por imagem , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/etiologia , Artéria Vertebral/diagnóstico por imagemRESUMO
Coronary subclavian steal syndrome is an uncommon cause of angina in patients with a previous coronary artery bypass graft procedure. The patient had chest pain with the exertion of the left upper limb, difference in blood pressure between the left and right arm, occlusion at the ostium of the left subclavian artery. He underwent carotid subclavian bypass surgery that was successful in relieving symptoms. On the other hand, the patient had an embolic stroke related to the procedure and further assessment may be necessary.
Assuntos
Síndrome do Roubo Coronário-Subclávio , Síndrome do Roubo Subclávio , Masculino , Humanos , Síndrome do Roubo Coronário-Subclávio/diagnóstico por imagem , Síndrome do Roubo Coronário-Subclávio/cirurgia , Síndrome do Roubo Coronário-Subclávio/complicações , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Angina Pectoris/etiologiaAssuntos
Síndrome Coronariana Aguda , Ataque Isquêmico Transitório , Litotripsia , Síndrome do Roubo Subclávio , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/terapia , Humanos , Ataque Isquêmico Transitório/complicações , Artéria Subclávia , Síndrome do Roubo Subclávio/complicações , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/terapiaRESUMO
CASE DESCRIPTION: A 5-year-old 4.1-kg (9.0-lb) spayed female Toy Poodle was referred because of a 6-month history of sporadic signs of neck pain. CLINICAL FINDINGS: Diagnostic imaging with MRI and CT revealed a dilated radicular artery connecting the right and left vertebral arteries and causing mild compression of the spinal cord. The left subclavian artery caudal to the origin of the left vertebral artery was absent. Subclavian steal syndrome (SSS) was suspected. TREATMENT AND OUTCOME: The owner declined surgical treatment; thus, the dog was treated conservatively with glucocorticoids and analgesics. Eight months later, the dog's clinical signs were unchanged but palliated with the administration of glucocorticoids and analgesics, and 4-dimensional (4-D) magnetic resonance angiography (MRA) revealed that the left vertebral artery received blood supply from the right vertebral artery through the dilated radicular artery and that the left vertebral artery caudal to this site had retrograde flow and drained into the left subclavian artery, confirming the diagnosis of SSS. The owner again declined surgery, and conservative treatment continued. The dog's condition was unchanged at the last follow-up communication 11 months after 4-D MRA. CLINICAL RELEVANCE: Subclavian steal syndrome is an extremely rare condition in dogs, and our findings suggested that 4-D MRA could be used to definitively diagnose SSS in dogs.
Assuntos
Doenças do Cão , Síndrome do Roubo Subclávio , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/veterinária , Artéria VertebralRESUMO
BACKGROUND: An aberrant right subclavian artery is the most common congenital anomaly of the aortic arch and may cause symptoms due to aneurysmal dilatation, stenosis or occlusion. We present a case of subclavian-steal syndrome due to post-traumatic dissection of an aberrant right subclavian artery. METHODS AND RESULTS: A 50 year-old man presented with dizziness and fainting episodes after exercising his right arm and a systolic blood pressure gradient of 40 mm Hg between the 2 arms. Suspecting a subclavian steal syndrome, a computed tomography angiography was requested which revealed an aberrant right subclavian artery with a severe stenosis proximal to the ostium of the vertebral artery. Transfemoral digital subtraction angiography showed a local dissection of the aberrant right subclavian artery with late retrograde filling of the ipsilateral vertebral artery. The lesion was successfully treated with primary stent implantation (9 mm x 40 mm, LIFESTAR, BARD). On interrogation, the patient recalled an injury to the right arm after falling off a ladder 10 years earlier, as a possible post-traumatic cause for the dissection. He had an uneventful outcome and is symptom-free 12 months down the line. CONCLUSIONS: The combination of post-traumatic dissection of an aberrant right subclavian artery resulting to subclavian steal syndrome is an extremely rare scenario. Endovascular management is a safe, minimally invasive alternative to open surgery.
Assuntos
Acidentes por Quedas , Angioplastia , Dissecção Aórtica/terapia , Anormalidades Cardiovasculares/complicações , Artéria Subclávia/anormalidades , Síndrome do Roubo Subclávio/terapia , Lesões do Sistema Vascular/terapia , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/etiologia , Dissecção Aórtica/fisiopatologia , Angioplastia/instrumentação , Anormalidades Cardiovasculares/diagnóstico por imagem , Anormalidades Cardiovasculares/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/etiologia , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologiaRESUMO
PURPOSE: Endovascular treatment for subclavian artery (SA) occlusive disease is well established; however, a potential risk remains for posterior circulation embolism, which can be life threatening. To reduce the risk of vertebral artery (VA) embolism, we have devised a transradial dual-balloon protection system referred to as the balloon switching technique. Herein, we describe a patient with left SA stenosis who successfully underwent SA stenting using the balloon switching technique. Case presentation A 79-year-old woman with left arm claudication was diagnosed with left subclavian steal syndrome due to severe stenosis of the proximal left SA. Endovascular revascularization using the balloon switching technique was employed. To obtain VA embolic protection during device advancement through the SA lesion, an 8F balloon-guiding catheter was inflated in the left SA at the level of the VA takeoff using the left transradial sheathless approach. A balloon-expandable stent was inflated in the SA lesion, followed by deflation of the balloon-guiding catheter. The stagnant left VA flow was flushed away toward the distal left SA. Following reinflation of the balloon-guiding catheter, the stent delivery system was deflated and removed. Floating debris in the SA proximal to the balloon-guiding catheter was adequately aspirated, followed by deflation of the balloon-guiding catheter. Left SA angiography showed successful revascularization, and postprocedural neuroimaging showed no evidence of ischemic stroke. CONCLUSIONS: The balloon switching technique reduces the risk of VA embolism during left SA stenting via the transradial access. This method is a useful therapeutic option for patients with left SA occlusive disease.
Assuntos
Angioplastia com Balão , Síndrome do Roubo Subclávio , Idoso , Feminino , Humanos , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/cirurgia , Resultado do Tratamento , Artéria VertebralAssuntos
Síndrome do Roubo Subclávio , Artéria Vertebral , Aorta Torácica , Tronco Braquiocefálico , Humanos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagemAssuntos
Anormalidades Cardiovasculares , Doenças do Cão , Síndrome do Roubo Subclávio , Animais , Anormalidades Cardiovasculares/veterinária , Doenças do Cão/diagnóstico por imagem , Cães , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/veterinária , UltrassonografiaRESUMO
Subclavian steal syndrome is a group of symptoms resulting fromretrograde flow in the vertebral artery, "stealing" blood from the posterior intracranial circulation and other territories, caused by stenosis or occlusion of the subclavian artery proximal to the origin of the same vertebral artery, or even of the brachiocephalic trunk. Most of the time, it is an incidental finding in patients with other conditions or cerebrovascular risk factors. We report a series of 29 patients with an angiographic diagnosis, in which 7 received treatment (all endovascular), all with symptoms directly related to this condition. Advanced age, systemic arterial hypertension, diabetes mellitus, smoking and stroke were comorbidities frequently related. Six patients improved completely after the procedure and one remained with vertigo.