-2 :: Case - 10940 :: - Subclavian Steal Syndrome
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Tx and Followup:
None at this time

Additional Discussion:
MRA of revealed absent signal in left vertebral artery due to reversal of flow and not occlusion. This is a potential pitfall in MR angiography.

Patency of the left vertebral artery was confirmed by CTA; and the proximal occlusion at the origin of the left subclavian artery was demonstrated.

Discussion Author: Andrew Fong

Subclavian Steal Syndrome occurs secondary to stenosis or occlusion of the proximal subclavian artery with perfusion to the upper extremity via retrograde flow from the ipsilateral vertebral artery. In most cases, this requires the presence of an intact circle of Willis on the affected side.

The patient may present with neurolgic symptoms such as dizziness, unsteadiness, vertigo, or visual changes as the normally antegrade flow in the ipsilateral vertebral artery is reversed-"stolen"-to perfuse the upper extremity. The patient may also complain of arm claudication and rest pain.

Subclavian Steal Syndrom usually affects patients older than 50 years and is due to atherosclerosis. Patients may present earlier if there is a history of vasculitis.

On physical exam one might appreciate weak or absent radial and ulnar pulses with concurrent reduced blood pressure.

Angiography reveals a proximal subclavian artery stenosis or occlusion, often with non-filling of the ipsilateral vertebral artery. Delayed images will show retrogrde flow from the vertebral artery to supply the upper extremity. Treatment may include stent placement (90% patency rate at 3 years) or a surgical bypass graft.

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