Transcurrir histórico de concepto y base etiopatogénica de un mismo síndrome: de Neri-Barré-Liéou, Insuficiencia Vertebro-Basilar y accidente isquémico transitorio en el territorio Vertebro-Basilar / Historic development and ethiophatogenic basis of Neri-Barré-Liéou, Vertebro-Basilar Insufficiency and Transient Ischemic Attacks in Vertebro-Basilar territory as one and the same syndrome

El síndrome de Insuficiencia Vertebro-Basilar es causado por una difusión transitoria de ciertas estructuras del Sistema Nervioso Central irrigadas por el complejo arterial Vertebro-Basilar. Durante este siglo este síndrome se ha conocido bajo distintos nombre debido a que ha sido atribuido a distintas etiopatogenias. En este artículo procedemos a explicar los cambios que ha sufrido este síndrome en su etiopatogenia y cómo ha afectado a su denominación (AU)

Subclavian steal syndrome. Part 1: Proximal vertebral to common carotid artery transposition in three patients, and historical review.

Three patients with central nervous system symptoms due to subclavian steal syndrome were treated with proximal vertebral to common carotid artery transposition. Neurological symptoms were relieved or improved in all three, with no decrease in blood pressure or pulse in the ipsilateral upper extremity. The colorful history of this syndrome is reviewed, and the various surgical approaches to its treatment are discussed. Although the literature suggests that the commonly used carotid to subclavian artery bypass graft and other similar extrathoracic procedures are generally safe and effective for relief of symptoms of the steal, there is also evidence that these bypasses may fail to restore antegrade flow in the vertebral artery, and, in fact, may steal from the carotid artery. Thus, the blood flow provided to the brain by these procedure may be hardly more than that provided by vertebral artery ligation, whereas the principal effect is to restore blood flow into the upper extremity. Vertebral artery ligation alone has been used in 20 patients, with neurological improvement in all cases and production of persistent intermittent brachial claudication in only one. These considerations and our patient experience suggest that a relatively simple operation, proximal vertebral to common carotid artery transposition, which emphasizes restoration of flow to the brain rather than to the upper extremity, may be preferable for most patients with neurological symptoms of subclavian steal syndrome.