Intravenous Thrombolytic Therapy for Acute Ischemic Stroke with Subclavian Arterial Steal Syndrome: A Case Report
Xiaoguang TongYuxin WangYan ChenChenhao ZhangChenhua LiZhong DongXiaowei ZhangFangfang ZhangHang YinJinhuan WangPei-Lan Zhang
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Subclavian steal syndrome
Stroke
Objective To analyze the causes of subclavian steal syndrome,hemodynamics and the relation to the reversal of blood flow in the ipsilateral vertebral artery and multi arteries in neck. Methods Forty nine patients diagnosed as subclavian steal syndrome by clinic were examined by color Doppler ultrasound. Results The main causes of subclavian steal syndrome were atherosclerosis and aortoarteritis. Conclusion When patients with subclavian steal syndrome companied with stenosis or occlusion of other carotid arteries,we can't estimate the degree of stenosis of proximal subclavian artery or innominate artery depending only on the flow of vertebral artery.
Subclavian steal syndrome
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Cases of cerebro-subclavian steal syndrome have been reported in the medical literature since 1960. This most often occurs on the left side because of the higher rate of involve ment of the left subclavian artery in comparison to the other brachiocephalic branches of the aortic arch. With the use of the internal mammory artery as a conduit for coronary artery bypass, in the past three decades increasing numbers of coronary-subclavian steal in addition to the cerebro-subclavian steal have been observed. The authors report a case of bilateral subclavian steal syndrome through both vertebral arteries, the right common carotid artery, and the left internal mammory artery, without significant signs and symptoms of cerebral ischemia or anginal pain.
Subclavian steal syndrome
Left subclavian artery
Brachiocephalic artery
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Subclavian steal syndrome
Left subclavian artery
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Subclavian steal syndrome
Left subclavian artery
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Bilateral subclavian steal syndromeF Arevalo and BT KatzenAudio Available | Share
Subclavian steal syndrome
Auscultation
Vertebrobasilar insufficiency
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Subclavian steal syndrome is a relatively rare condition that results from occlusion of the subclavian artery proximal to the origin of the vertebral artery.This causes a reversal in the direction of the blood flow in the vertebral artery, leading to symptoms of vertebrobasilar insufficiency.In this article, we report a case of subclavian steal syndrome in an elderly female, who was investigated with Doppler and CT angiography in our department.
Subclavian steal syndrome
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Left subclavian artery
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Subclavian steal syndrome is caused by proximal subclavian occlusion with retrograde filling of the subclavian artery via the vertebral artery. This syndrome is characterized by symptoms due to decreased cerebral blood flow and decreased blood flow to the arm and hand. It is twice as common in men as in women. Diagnosis is confirmed with angiography. Medical management is of limited value. Surgery is the treatment of choice for the symptomatic patient.
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Traumatic obstruction of the subclavian artery without major hemorrhage is rare. Only eleven cases have been disclosed retrograde flows from the ipsilateral vertebral artery into the distal segment of subclavian artery in the world. One case of the traumatic subclavian occlusion is presented in this paper. A 63-year-old man was struck on his chest by heavy machinery. On admission he was alert and had no neurological deficits. His blood pressure was 140/80 mmHg in his right arm but was not palpable in his left radial artery. Aortogram showed incomplete obstruction of the left subclavian artery 2 cm beyond its origin. On the second admission day it was occluded and the distal flow was supplied from the left vertebral artery in a retrograde fashion. Without operative vascular reconstruction he has never experienced ischemic symptoms for a year.
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Left subclavian artery
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A subclavian or innominate artery obliteration may cause a retrograde flow in the vertebral artery, a subclavian steal. The steal has been associated with cerebral symptoms indicating vertebrobasilar ischaemia, the subclavian steal syndrome. As there still are no objective means of measuring the effect of the steal on the brain circulation, the syndrome can only be proved by experience from the results of surgical attempts to correct the steal. The steal was at first eliminated by direct reconstruction of the subclavian and innominate arteries through a thoracic approach. As the mortality was high, many surgeons have used cervical bypass procedures with considerably lower mortality. The present report is based on 15 years' experience with 85 patients operated on with direct artery reconstruction through a thoracotomy. A low mortality (1.3%) for the last ten years, a high patency of the reconstruction (80%) 8 years postoperatively and a rather high rate of improvement (72%) in patients with subclavian steal syndrome were found. The study shows that the mortality rate with the thoracic approach need not necessarily be higher than with the cervical one. The high patency and the haemodynamically correct type of the reconstructions favour the thoracic approach. However, the direct reconstruction demands a technically advanced surgeon. who is well aquainted with the method. The results also showed that surgery still may be an alternative in patients with symptomatic subclavian steal.
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Subclavian steal syndrome (SSS) is produced by occlusion of the proximal subclavian artery and subsequent retrograde filling of the subclavian artery via the vertebral artery. The resulting alteration of blood flow may cause a variety of symptoms secondary to decreased blood supply to the brain and upper extremity of the affected side. A case of severe brain stem ischemia caused by SSS was reported. We performed a subclavian-subclavian graft shunt for this patient and obtained good results. Such a case has been only rarely described in the literature. Complementary information obtained from digital subtraction angiography, computed tomography and MRI helped to establish a correct preoperative and postoperative diagnosis.
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