The Subclavian Steal Syndrome
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Abstract:
"The subclavian steal" is a retrograde flow of blood from the vertebral-basilar system into the subclavian artery. The vertebral arteries participate in the collateral circulation around the first portion of the subclavian artery. This syndrome occurs when the first portion of the subclavian artery is occluded. The blood pressure in the distal subclavian artery is decreased to the point where it is lower than the pressure in the vertebral-basilar system and therefore blood flows in a retrograde fashion. This paper is a report of two cases of occlusion of the right subclavian artery proximal to the origin of the vertebral artery. One patient exhibited a reversal of blood flow so as to siphon blood from the brain to the arm. The second patient demonstrated a similar anatomic picture but not the retrograde vertebral artery flow. Both patients were studied by arteriograms and treated by reconstituting the blood flow to theKeywords:
Subclavian steal syndrome
Collateral circulation
Vertebrobasilar insufficiency
Subclavian "steal", when blood siphons from one vertebral artery to the other, has been suggested as a cause of brain stem ischaemia and stroke. We investigated 33 patients using transcranial Doppler to determine the direction and velocity of basilar blood flow. All patients had severe subclavian stenosis with reversed vertebral blood flow in the ipsilateral artery previously demonstrated by extracranial Doppler. Basilar flow was normal in direction in all cases, but its velocity was significantly increased (p less than 0.0008) compared to age- and sex-matched controls. These findings, in conjunction with previous observations using extracranial Doppler techniques, suggest that subclavian steal is little more than a harmless haemodynamic phenomenon.
Subclavian steal syndrome
Vertebrobasilar insufficiency
Transcranial Doppler
Left subclavian artery
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Objective To explore the collateral compensation and clinical characteristics of severe subclavian steal syndrome(SSS).Methods The clinical data of 12 patients with severe SSS conformed by cerebral digital subtraction angiography(DSA) were analyzed retrospectively.Results The main clinical manifestations of the 12 SSS patients were repeated dizzy,feeling rotation,falling down and so on,and which became aggravate after activities with ipsilateral unper limb.DSA showed that the left subclavian artery severe stenosis or occlusion in 10 cases and bilateral subclavian artery severe stenosis in 2 cases.The ways of collateral compensation were vertebral artery-vertebral artery-subclavian artery in 10 cases,internal carotid artery-posterior communicating artery-posterior cerebral artery/basilar artery in 8 cases,external carotid artery-occipital artery inferior branches-ramimusculares arteriae vertebralis-vertebral artery-subclavian artery in 9 cases.The 8 cases recived subclavian artery stent angioplasty and the clinical symptoms were completely disappeared.The 2 cases recived contralateral vertebral artery stent angioplasty because who had with subclavian artery occlusion and contralateral vertebral artery moderate stenosis.After operation the symptoms were relieved,and also no recurrenced after following up 3 months-2.5 years.Conclusions Repeated dizzy is the main clinical symptom of severe SSS.The main way of collateral compensation is vertebral artery-vertebral artery-subclavian artery.The stent angioplasty can correct the hemodynamics disorder and relieve the clinical symptoms.
Vertebrobasilar insufficiency
Subclavian steal syndrome
Occipital artery
SSS*
Digital subtraction angiography
External carotid artery
Collateral circulation
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Subclavian steal syndrome
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Five patients with subclavian artery stenosis, reversed vertebral artery blood flow, and basilar arterial insufficiency have been described. Four patients were successfully treated by arterial reconstruction. Serial angiography demonstrated in each case a stenosis of the subclavian artery proximal to the origin of the vertebral artery, with delayed retrograde flow through this vertebral artery to the subclavian artery distally.
Subclavian steal syndrome
Vertebrobasilar insufficiency
Left subclavian artery
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Doppler sonography
Vertebrobasilar insufficiency
Subclavian steal syndrome
Doppler ultrasound
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ABSTRACT: Subclavian “steal”, when blood siphons from one vertebral artery to the other, has been suggested as a cause of brain stem ischaemia and stroke. We investigated 33 patients using transcranial Doppler to determine the direction and velocity of basilar blood flow. All patients had severe subclavian stenosis with reversed vertebral blood flow in the ipsilateral artery previously demonstrated by extracranial Doppler. Basilar flow was normal in direction in all cases, but its velocity was significantly increased (p<0.0008) compared to age- and sex-matched controls. These findings, in conjunction with previous observations using extracranial Doppler techniques, suggest that subclavian steal is little more than a harmless haemodynamic phenomenon.
Subclavian steal syndrome
Vertebrobasilar insufficiency
Transcranial Doppler
Left subclavian artery
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The studies of Hutchinson and Yates on caroticovertebral stenosis have stimulated further interest in cerebrovascular disease. As a consequence, investigation of the four vessels, supplying the brain is now routine in the assessment of patients being considered for surgery for occlusive disease of the vessels. This has led to some interesting and unexpected findings.The effect of subclavian artery disease on the vertebrobasilar circulation was studied in two patients. Angiography showed the vertebral arteries to function as a collateral pathway when an occlusion of the subclavian artery was present proximal to the origin of the vertebral arteries. In one case both the carotid and the vertebral arteries were implicated in the collateral supply. A normal circulation was restored by subclavian endarterectomy.Studies of other workers have shown that such a circulation may reduce the cerebral blood flow by about 40%, but neither patient described in this report had signs or symptoms of cerebrovascular disease. It is evident that our understanding of the effects of cerebrovascular disease is far from complete.
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Transcranial Doppler
Amaurosis fugax
Subclavian steal syndrome
Vertebrobasilar insufficiency
Collateral circulation
Cerebral circulation
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Subclavian steal syndrome
Vertebrobasilar insufficiency
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ABSTRACT A patient presented with vertebrobasilar insufficiency during exertion. Vertebral duplex and transcranial Doppler ultrasonography showed reversal of flow in both intracranial and extracranial vertebral and basilar arteries, suggesting bilateral subclavian and vertebrobasilar steal. Electron beam computed tomography angiography (CTA) showed no evidence of subclavian artery stenosis including normal vertebral artery origin on both sides. However, digital subtraction angiography revealed complete occlusion of both subclavian arteries with retrograde flow from both vertebral and basilar arteries to reconstitute both subclavian arteries. This false‐negative finding on CTA in detection of subclavian steal syndrome (SSS) is due to inappropriate contrast administration technique and postprocessing method, inability to differentiate flow direction, and lack of hemodynamic time sequences. This study demonstrates a pitfall of CTA in diagnosis of SSS compared to more reliable hemodynamic information obtained by duplex and transcranial Doppler ultrasonography, and digital subtraction angiography.
Subclavian steal syndrome
Digital subtraction angiography
Vertebrobasilar insufficiency
SSS*
Computed Tomography Angiography
Transcranial Doppler
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