Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 1.914
Filter
1.
Sci Rep ; 14(1): 14290, 2024 06 21.
Article in English | MEDLINE | ID: mdl-38906992

ABSTRACT

To investigate the effect and safety of percutaneous endovascular angioplasty (PEA) with optional stenting for the treatment of severe stenosis or occlusion of subclavian artery, patients with severe stenosis ≥ 70% or occlusion of subclavian artery treated with PEA were retrospectively enrolled. The clinical data were analyzed. A total of 222 patients were retrospectively enrolled, including 151 males (68.0%) and 71 females (32.0%) aged 48-86 (mean 63.9 ± 9.0) years. Forty-seven (21.2%) patients had comorbidities. Subclavian artery stenosis ≥ 70% was present in 201 (90.5%) patients and complete subclavian occlusion in 21 (9.5%) cases. Angioplasty was successfully performed in all (100%) patients. Balloon-expandable stents were used in 190 (85.6%) cases, and self-expandable stents in 20 (9.0%) cases. Only 12 (5.4%) cases were treated with balloon dilation only. Among 210 patients treated with stent angioplasty, 71 (33.8% or 71/210) cases underwent balloon pre-dilation, 139 (66.2% or 139/210) had direct deployment of balloon-expandable stents, and 2 (1.0% or 2/210) experienced balloon post-dilation. Distal embolization protection devices were used in 5 (2.3% or 5/222) cases. Periprocedural complications occurred in 3 (1.4%) patients, including aortic dissection in 2 (0.9%) cases and right middle cerebral artery embolism in 1 (0.5%). No hemorrhage occurred. Among 182 (82.0%) patients with 6-month follow-up, restenosis > 70% occurred in 1 (0.5%) patient, and among 68 (30.6%) patients with 12-month follow-up, restenosis > 70% took place in 11 (16.2%) patients. Percutaneous endovascular angioplasty can be safely and efficiently performed for the treatment of severe stenosis ≥ 70% or occlusion of subclavian artery.


Subject(s)
Stents , Subclavian Artery , Humans , Male , Female , Aged , Middle Aged , Aged, 80 and over , Subclavian Artery/surgery , Retrospective Studies , Stents/adverse effects , Treatment Outcome , Subclavian Steal Syndrome/therapy , Subclavian Steal Syndrome/surgery , Endovascular Procedures/methods , Endovascular Procedures/adverse effects , Angioplasty/methods , Angioplasty/adverse effects , Constriction, Pathologic/therapy , Angioplasty, Balloon/methods , Angioplasty, Balloon/adverse effects , Arterial Occlusive Diseases/therapy , Arterial Occlusive Diseases/surgery
2.
J Med Case Rep ; 18(1): 226, 2024 May 08.
Article in English | MEDLINE | ID: mdl-38715146

ABSTRACT

BACKGROUND: Perioperative symptomatic carotid artery occlusion after carotid endarterectomy is a rare complication. In this study, we present a case of symptomatic acute carotid artery occlusion that occurred after carotid endarterectomy in a patient with coexistent subclavian artery steal phenomenon, which was successfully treated with subclavian artery stenting. CASE PRESENTATION: A 57-year-old East Asian female presented with stenosis in the left common carotid artery and left subclavian artery along with subclavian steal. The proximal segment of the left anterior cerebral artery was hypoplastic, and the posterior communicating arteries on both sides were well-developed. Left internal carotid artery stenosis progressed during the follow-up examination; therefore, left carotid endarterectomy was performed. On the following day, symptoms of cerebral perfusion deficiency appeared due to occlusion of the left carotid artery. The stenotic origin of the left common carotid artery and the suspected massive thrombus in the left carotid artery posed challenges to carotid revascularization. Therefore, left subclavian artery stenting for the subclavian steal phenomenon was determined to be the best option for restoring cerebral blood flow to the whole brain. Her symptoms improved after the procedure, and the postprocedural workup revealed improved cerebral blood flow. CONCLUSION: Subclavian artery stenting is safe and may be helpful in patients with cerebral perfusion deficiency caused by intractable acute carotid occlusion coexisting with the subclavian steal phenomenon. Revascularization of asymptomatic subclavian artery stenosis is generally not recommended. However, cerebral circulatory insufficiency as a comorbidity may be worth considering.


Subject(s)
Carotid Stenosis , Cerebrovascular Circulation , Endarterectomy, Carotid , Stents , Subclavian Steal Syndrome , Humans , Female , Subclavian Steal Syndrome/surgery , Middle Aged , Carotid Stenosis/surgery , Treatment Outcome , Subclavian Artery/surgery , Postoperative Complications/surgery , Postoperative Complications/etiology
3.
Angiol. (Barcelona) ; 76(1): 53-55, ene.-feb. 2024. ilus
Article in Spanish | IBECS | ID: ibc-231200

ABSTRACT

Introducción: el síndrome de robo de la subclavia es una entidad poco habitual que se presenta en pacientes con estenosis u oclusión de la arteria subclavia, habitualmente la izquierda, y secundario a ateroesclerosis. Los síntomas derivados de esta entidad son: la isquemia del miembro superior y los síntomas neurológicos. Caso clínico: se presenta un caso de un varón que, tras cinco meses de tratamiento endovascular de úlcera de aorta torácica penetrante, presenta síntomas neurológicos. Se realizó diagnóstico del síndrome a través de eco Doppler y se confirmó con angio RM. Finalmente, y debido a la incapacidad que producían los síntomas, se decidió tratamiento quirúrgico mediante cirugía de bypass carótido subclavio izquierdo. Discusión: el síndrome del robo de la subclavia es una entidad que raramente se presenta asociada a síntomas. Debe tenerse una alta sospecha para diagnosticarlo y tratarlo si es necesario. Aunque la tendencia actual es el tratamiento endovascular, en ocasiones la cirugía de derivación tradicional es la única opción. Siempre que sea posible, debe estudiarse la dominancia de las arterias vertebrales antes de ocluir la arteria subclavia en los procedimientos. (AU)


Introduction: subclavian steal syndrome is a rare entity, occurring in patients with stenosis or occlusion of the subclavian artery, usually the left subclavian artery and secondary to atherosclerosis. The symptoms derived from this entity are: ischemia of the upper limb and neurological symptoms. Case report: we present a case of a man who, after five months of endovascular treatment of penetrating thoracic aortic ulcer, presented neurological symptoms. The syndrome was diagnosed by echo-Doppler and confirmed by MRI angiography. Finally, due to the incapacity caused by the symptoms, surgical treatment was decided by left carotid-subclavian bypass. Discussion: subclavian steal syndrome is an entity rarely presents with symptoms, it must be highly suspected in order to diagnose it and, if necessary, treat it. Although, the current trend is endovascular treatment, sometimes traditional bypass surgery is the only option. Whenever possible, the dominance of the vertebral arteries should be studied before occluding the subclavian artery in the procedures. (AU)


Subject(s)
Humans , Male , Aged , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/surgery , Aorta, Thoracic/injuries , Ischemia
4.
Khirurgiia (Mosk) ; (12): 95-102, 2023.
Article in Russian | MEDLINE | ID: mdl-38088846

ABSTRACT

Severe subclavian artery lesion is an important medical and social problem worsening the quality of life and leading to dire consequences. Vertebrobasilar insufficiency is the main syndrome of lesion of the first segment of subclavian artery. About 20% of all ischemic strokes occur in vertebrobasilar basin. At present, surgical treatment of asymptomatic patients with severe lesion of the 1st segment of subclavian artery is still debatable. Open surgery is optimal for occlusion of this vascular segment. Carotid-subclavian transposition is a preferable option with favorable in-hospital and long-term results. However, carotid-subclavian bypass is an equivalent alternative in case of difficult transposition following anatomical and topographic features of vascular architectonics. Endovascular treatment is preferable for isolated subclavian artery stenosis and should certainly include stenting.


Subject(s)
Atherosclerosis , Subclavian Steal Syndrome , Vertebrobasilar Insufficiency , Humans , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery , Quality of Life , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/etiology , Subclavian Steal Syndrome/surgery , Atherosclerosis/complications , Atherosclerosis/diagnosis , Atherosclerosis/surgery , Vertebrobasilar Insufficiency/diagnosis , Vertebrobasilar Insufficiency/etiology , Vertebrobasilar Insufficiency/surgery , Stents , Treatment Outcome
6.
Methodist Debakey Cardiovasc J ; 19(1): 49-54, 2023.
Article in English | MEDLINE | ID: mdl-37576086

ABSTRACT

A 70-year-old veteran with prior triple vessel coronary artery bypass grafting (CABG) presented with exertional chest pain. His work-up revealed > 40 mm Hg bilateral upper extremity blood pressure difference. Chest computed tomography and invasive angiography revealed severe stenosis at the ostium of the left subclavian artery, proximal to the origin of the left internal mammary artery to left anterior descending artery graft (LIMA-LAD). A diagnosis of coronary subclavian steal syndrome (CSSS) was made, and carotid-subclavian bypass was performed. This case outlines when to suspect CSSS, an approach to its diagnosis, and the importance of its timely management.


Subject(s)
Subclavian Steal Syndrome , Humans , Aged , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/surgery , Theft , Coronary Artery Bypass/adverse effects , Subclavian Artery , Chest Pain
8.
Eur Heart J ; 44(30): 2805-2814, 2023 08 07.
Article in English | MEDLINE | ID: mdl-37264699

ABSTRACT

The colorful term "coronary steal" arose in 1967 to parallel "subclavian steal" coined in an anonymous 1961 editorial. In both instances, the word "steal" described flow reversal in the setting of an interconnected but abnormal vascular network-in one case a left subclavian stenosis proximal to the origin of the vertebral artery and in the other case a coronary fistula. Over time, the term has morphed to include a larger set of pathophysiology without explicit flow reversal but rather with a decrease in stress flow due to other mechanisms. This review aims to shed light on this phenomenon from a clinical and a pathophysiological perspective, detailing the anatomical and physiological conditions that allow so-called steal to appear and offering treatment options for six distinct scenarios.


Subject(s)
Coronary Artery Disease , Coronary-Subclavian Steal Syndrome , Subclavian Steal Syndrome , Humans , Vertebral Artery , Heart
9.
BMJ Case Rep ; 16(4)2023 Apr 25.
Article in English | MEDLINE | ID: mdl-37185244

ABSTRACT

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.


Subject(s)
Subclavian Artery , Subclavian Steal Syndrome , Female , Humans , Subclavian Artery/diagnostic imaging , Subclavian Steal Syndrome/diagnostic imaging , Vertebral Artery/diagnostic imaging , Constriction, Pathologic/complications , Aorta, Thoracic , Pain/complications
11.
Neurol Med Chir (Tokyo) ; 63(6): 221-227, 2023 Jun 15.
Article in English | MEDLINE | ID: mdl-37005246

ABSTRACT

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.


Subject(s)
Carotid Artery Diseases , Carotid Stenosis , Subclavian Steal Syndrome , Thrombosis , Humans , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/surgery , Constriction, Pathologic , Carotid Artery, Common/surgery , Carotid Artery, Internal/surgery , Carotid Artery Diseases/surgery , Subclavian Steal Syndrome/diagnostic imaging , Subclavian Steal Syndrome/surgery
12.
ESC Heart Fail ; 10(3): 2084-2089, 2023 06.
Article in English | MEDLINE | ID: mdl-36871950

ABSTRACT

Coronary subclavian steal syndrome (CSSS) caused by left subclavian artery (LSA) stenosis is a rare cause of myocardial infarction in patients having coronary artery bypass grafting (CABG), and it has also been observed after an arteriovenous fistula (AVF) was made. A 79-year-old woman who had undergone CABG years earlier and an AVF creation 1 month before experienced a non-ST-elevation myocardial infarction (NSTEMI). While selective catheterization of the left internal thoracic artery graft was impossible, a computed tomography scanner showed patency of all bypasses and proximal subocclusive LSA stenosis, and the digital blood pressure measurements objectified a haemodialysis-induced distal ischaemia. LSA's angioplasty and covered stent placement were successfully performed, resulting in symptom remission. A CSSS-induced NSTEMI due to a LSA stenosis aggravated by a homolateral AVF several years after CABG has been documented only infrequently. If vascular access is required in the presence of CSSS risk factors, the contralateral upper limb should be preferred.


Subject(s)
Coronary-Subclavian Steal Syndrome , Myocardial Infarction , Non-ST Elevated Myocardial Infarction , Subclavian Steal Syndrome , Female , Humans , Aged , Coronary-Subclavian Steal Syndrome/diagnosis , Coronary-Subclavian Steal Syndrome/etiology , Coronary-Subclavian Steal Syndrome/surgery , Constriction, Pathologic/complications , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/etiology , Subclavian Steal Syndrome/surgery , Myocardial Infarction/complications
13.
Eur Rev Med Pharmacol Sci ; 27(5): 1881-1888, 2023 03.
Article in English | MEDLINE | ID: mdl-36930485

ABSTRACT

OBJECTIVE: Assessment of the monocyte-to-high-density lipoprotein ratio (MHR) is a new tool for predicting inflammation, which plays a major role in atherosclerosis. Subclavian artery stenosis (SAS) is usually asymptomatic, and atherosclerosis is the most common cause of chronic obstruction of the subclavian artery in adults. The aim of this study was to determine the relationship between the MHR and SAS. PATIENTS AND METHODS: Between January 2015 and January 2020, 43 patients with SAS and 43 patients without SAS were enrolled in the study. The patients' angiographic, demographic and clinic characteristics were reviewed from their medical records. Monocytes and HDL (high-density lipoprotein) cholesterols were measured through a complete blood count. The MHR was calculated as the ratio of the absolute monocyte count to the HDL cholesterol value. The resulting MHR values were divided into the following three groups: low (7.16 ± 1.59), moderate (11.08 ± 1.53) and high (21.70 ± 5.62). A p-value of less than 0.05 was considered significant. RESULTS: MHR was found to be significantly higher in the SAS group compared to the control group with normal subclavian arteries (p<0.001). The frequency of SAS was found to increase with an increase in the MHR tertiles. Sensitivity and specificity values were 69.8% and 95.3%, respectively. The cut-off of the MHR value, taken as 13.39, was found to provide a significantly accurate prediction of the subclavian diagnosis (ROC area under the curve: 0.868, 95% CI: 0.789-0.947, p<0.001). After adjusting for other hematological parameters in the multivariate analysis, MHR (p=0.061) was found to be a predictor of the presence of SAS. CONCLUSIONS: This study showed that MHR can be a convenient marker for predicting SAS because of the correlation between MHR and SAS.


Subject(s)
Atherosclerosis , Subclavian Steal Syndrome , Adult , Humans , Lipoproteins, HDL , Monocytes , Cholesterol, HDL , Atherosclerosis/diagnosis , Biomarkers
14.
Clin Res Cardiol ; 112(9): 1204-1211, 2023 Sep.
Article in English | MEDLINE | ID: mdl-36239814

ABSTRACT

We retrospectively analyzed patient records of all patients with a history of internal mammarian artery (IMA) coronary bypass undergoing coronary angiography at two cardiovascular centers between January 1st 1999 and December 31st 2019. A total of 11,929 coronary angiographies with or without percutaneous coronary intervention were carried out in 3921 patients. Our analysis revealed 82 (2%) patients with documented subclavian artery stenosis. Of these, 8 (10%) patients were classified as having mild, 18 (22%) moderate, and 56 (68%) severe subclavian artery stenosis. In 7 (9%) patients with subclavian artery stenosis, angiography revealed occlusion of the IMA graft. 26 (32%) patients with severe subclavian artery stenosis underwent endovascular or surgical revasculararization of the subclavian artery. In this retrospective multicenter study, subclavian artery stenosis was a relevant finding in patients with an internal mammarian artery coronary bypass graft undergoing coronary angiography. The development of dedicated algorithms for screening and ischemia evaluation in affected individuals may improve treatment of this potentially underdiagnosed and undertreated condition.


Subject(s)
Angioplasty, Balloon , Coronary Artery Disease , Subclavian Steal Syndrome , Humans , Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/surgery , Subclavian Steal Syndrome/prevention & control , Retrospective Studies , Subclavian Artery/surgery , Coronary Angiography
15.
Am J Case Rep ; 23: e937015, 2022 Oct 26.
Article in English | MEDLINE | ID: mdl-36284464

ABSTRACT

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.


Subject(s)
Coronary-Subclavian Steal Syndrome , Drug-Eluting Stents , Subclavian Steal Syndrome , Tachycardia, Ventricular , Female , Humans , Aged , Subclavian Steal Syndrome/diagnostic imaging , Subclavian Steal Syndrome/etiology , Subclavian Steal Syndrome/therapy , Coronary-Subclavian Steal Syndrome/diagnostic imaging , Coronary-Subclavian Steal Syndrome/complications , Drug-Eluting Stents/adverse effects , Coronary Artery Bypass
16.
Tex Heart Inst J ; 49(5)2022 09 01.
Article in English | MEDLINE | ID: mdl-36191603

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.


Subject(s)
Subclavian Steal Syndrome , Vascular Ring , Aorta, Thoracic/abnormalities , Aorta, Thoracic/diagnostic imaging , Cardiovascular Abnormalities , Humans , Infant , Subclavian Artery/abnormalities , Subclavian Artery/diagnostic imaging , Vascular Ring/complications , Vascular Ring/diagnosis
17.
Ann Ital Chir ; 93: 470-475, 2022.
Article in English | MEDLINE | ID: mdl-36156492

ABSTRACT

AIM: To evaluate the outcomes of endovascular therapy in patients with subclavian steno-occlusive disease over the short and long term in a Tunisian population. MATERIALS AND METHODS: Patients who underwent endovascular treatment of subclavian artery (SCA) steno-occlusive disease between 2013 and 2019 in three Tunisian centers were evaluated retrospectively. After treatment, patients were follow-up was scheduled at 1, 3, 6, 12 months postoperatively and annually afterwards by Doppler ultrasound and clinical findings. Primary outcomes included technical, clinical procedural success rates and limb salvage rate. Secondary outcomes included the occurrence of periprocedural complications and primary patency rates. RESULTS: 56 patients (33 males, 58.9%) were evaluated. Patients' mean age was 61.5 + years. Technical success rate was 94.6 %, being 100% in case of stenosis and 78.5% in case of occlusion. The technical success rate was 94.6%. The clinical success rate was 100% and the upper limb salvage rate was 100%. Minor amputations were performed on 5 patients. Perioperative mortality and morbidity rates were 0% and 8.9% respectively. Mean follow-up was 26.7±16.4 months (range 12-86 months). Two in-stent restenosis occurred (at 12 and 15 months) and one case of thrombosis at the 16th month. The primary patency rates were 88.7%+4.3% at the end of the first year and 78.7%+6.1% at 3 years. CONCLUSION: Endovascular treatment can be considered as a safe and effective treatment of SCA steno-occlusive disease, with low perioperative complication rates and a good patency rates over long term. KEY WORDS: Subclavian artery stenosis, Subclavian artery occlusion, endovascular, subclavian revascularization.


Subject(s)
Arterial Occlusive Diseases , Endovascular Procedures , Subclavian Steal Syndrome , Arterial Occlusive Diseases/surgery , Constriction, Pathologic/etiology , Endovascular Procedures/adverse effects , Humans , Male , Middle Aged , Retrospective Studies , Stents , Subclavian Artery/surgery , Subclavian Steal Syndrome/etiology , Subclavian Steal Syndrome/surgery , Treatment Outcome
18.
Perm J ; 26(4): 106-109, 2022 12 19.
Article in English | MEDLINE | ID: mdl-36036849

ABSTRACT

Introduction Subclavian steal syndrome is a phenomenon of arterial flow reversal secondary to occlusive disease in proximal subclavian arteries, occasionally resulting in neurologic sequelae. Case Presentation The authors present the case of a 67-year-old man with stroke risk factors and a history of receiving head and neck radiation therapy who developed subclavian steal physiology leading to a transient ischemic attack and posterior circulation stroke. He was medically optimized without substantial progression or recurrence of disease. Conclusion This case illustrates a case of vertebrobasilar transient ischemic attack and posterior circulation stroke from subclavian steal syndrome in the setting of prior radiation therapy manifesting as extremity weakness and discoordination. Further research on therapeutic radiation dosages and subsequent incidence of arterial disease which could contribute to subclavian steal syndrome is necessary.


Subject(s)
Ischemic Attack, Transient , Stroke , Subclavian Steal Syndrome , Male , Humans , Aged , Subclavian Steal Syndrome/etiology , Subclavian Steal Syndrome/complications , Ischemic Attack, Transient/complications , Subclavian Artery , Stroke/complications , Risk Factors
19.
J Vasc Surg ; 76(6): 1634-1641, 2022 12.
Article in English | MEDLINE | ID: mdl-35835320

ABSTRACT

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.


Subject(s)
Carotid Stenosis , Stroke , Subclavian Steal Syndrome , Humans , Vertebral Artery/diagnostic imaging , Carotid Stenosis/complications , Constriction, Pathologic/complications , Stents/adverse effects , Subclavian Steal Syndrome/diagnostic imaging , Subclavian Steal Syndrome/therapy , Stroke/diagnostic imaging , Stroke/etiology
20.
BMJ Case Rep ; 15(5)2022 May 27.
Article in English | MEDLINE | ID: mdl-35623654

ABSTRACT

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.


Subject(s)
Aortic Aneurysm, Thoracic , Aortic Dissection , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Subclavian Steal Syndrome , Aortic Dissection/complications , Aortic Aneurysm, Thoracic/complications , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures/adverse effects , Headache/etiology , Headache/surgery , Humans , Subclavian Steal Syndrome/diagnostic imaging , Subclavian Steal Syndrome/etiology , Subclavian Steal Syndrome/surgery
SELECTION OF CITATIONS
SEARCH DETAIL
...