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Chronic vertebrobasilar insufficiency in subclavian steal syndrome.

ABSTRACT: Subclavian steal syndrome is a vascular disorder that consists of significant blood supply restriction with resultant insufficiency of the vertebrobasilar artery and the subclavian artery causing symptomatic insufficiency to the brain and upper extremity. It is important to recognize this condition in patients with subacute to chronic posterior circulation vascular insufficiency as early diagnosis and treatment can have good clinical outcomes (J Clin Neurosci. 2010;17:1339). CT angiogram of the head and neck should be considered in patients with chronic vertebrobasilar insufficiency to evaluate subclavian steal syndrome.

SUBMITTER: Phillips S

PROVIDER: S-EPMC7981698 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Chronic vertebrobasilar insufficiency in subclavian steal syndrome.

Phillips Stephanie S Memon Anza B AB

Clinical case reports 20210204 3

Subclavian steal syndrome is a vascular disorder that consists of significant blood supply restriction with resultant insufficiency of the vertebrobasilar artery and the subclavian artery causing symptomatic insufficiency to the brain and upper extremity. It is important to recognize this condition in patients with subacute to chronic posterior circulation vascular insufficiency as early diagnosis and treatment can have good clinical outcomes (J Clin Neurosci. 2010;<b>17</b>:1339). CT angiogram ...[more]

PMID: 33768958

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Coronary subclavian steal.

Project description: Not available

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Coronary subclavian steal syndrome causing acute coronary syndrome: a case report.

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The Importance of Subclavian Angiography in the Evaluation of Chest Pain: Coronary-Subclavian Steal Syndrome.

Project description:Routine preoperative screening for the presence of brachiocephalic disease using ultrasonic duplex or angiography is a cost-effective and essential means to prevent the development of rare occurrences of coronary-subclavian steal syndrome.

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Coronary subclavian steal syndrome due to thrombosis of the left subclavian artery aneurysm: a case report.

Project description:BackgroundCoronary subclavian steal syndrome (CSSS) is an often easily overlooked cause of angina that may occur after a coronary artery bypass graft (CABG) procedure. The onset of CSSS several years after coronary revascularization has been described in case reports, and in the few retrospective reviews that compare the endovascular approach with surgical treatment. Subclavian stenosis can naturally coincide with coronary artery disease and may already be present during the initial CABG.Case summaryA 59-year-old male with a history of three-vessel disease who had a left internal mammary artery (LIMA) bypass graft, exhibited a gradual worsening of angina that coincided with numbness and impaired function of the left fingers, hand, and arm. Myocardial perfusion imaging showed reversible ischaemia, and coronary angiography suggested a thrombotic lesion proximal to the LIMA ostium. Calcified and partially thrombosed proximal left subclavian artery (LSA) aneurysm was visualized using computed tomography imaging, whereas Doppler ultrasound revealed a partially reversed vertebral flow. The lowest risk treatment was a bypass between the left common carotid artery and the LSA. The procedure was immediately successful, with cessation of symptoms and a favourable medium-term outcome.DiscussionAs no guidelines exist for such cases, the importance of multidisciplinary co-operation in diagnostics and devising a treatment plan is underlined. Moreover, screening for subclavian artery stenosis in CABG candidates should be warranted as part of the initial preoperative assessment.

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Coronary subclavian steal syndrome-is there a need for routine assessment for subclavian artery stenosis following coronary bypass surgery?

Project description:Subclavian artery stenosis (SAS) resulting in coronary subclavian steal syndrome (CSSS) is a common but under recognized pathology following coronary artery bypass surgery (CABG). Patients with SAS may be asymptomatic due to the sub-clinical diversion of blood flow from the myocardium and retrograde blood flow during catheter angiography in the left internal mammary artery (LIMA) may be the first suggestion of CSSS. The management of SAS, causing CSSS, may rarely require acute assessment and intervention. However, full anatomical assessment of the stenosis morphology may be limited on fluoroscopy. Correction of SAS may be essential to achieve effective reperfusion therapy.

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Project description: Not available

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Successful treatment of total occluded innominate artery in a patient with subclavian steal syndrome.

Project description: Not available

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Diagnostic Investigations as a Basis for Optimising Surgical Management of Vertebrobasilar Insufficiency Syndrome.

Project description:Vertebrobasilar insufficiency (VBI) is one of the most common forms of cerebrovascular pathology. The progression of the VBI, especially in the context of inadequate therapy, often leads to the formation of a persistent neurological deficits within the framework of dyscirculatory encephalopathy and the consequences of a stroke in the vertebrobasilar system. This study demonstrate the importance of objective methods of patient investigation to optimize the choice of the most effective methods of surgical treatment for VBI in cases of ineffective medical treatment. We have shown that the optimization of the diagnostic algorithm contributes to the correct individualized determination of types of surgical treatment for patients with VBI. It was found that, in addition to traditional diagnostic methods, the use of radiographic methods (ultrasound Doppler, multispiral computed tomography with contrast enhancement) is invaluable for choosing the tactics of surgical treatment. We propose a significant outcome indicator like the blood flow reactivity index to determine the postoperative improvement of blood flow in the vertebral arteries. In addition, the need to perform cerebral angiography and consultations with related specialists to exclude pathologies with a similar clinical picture is emphasized.

| S-EPMC9150087 | biostudies-literature

Coronary-subclavian steal syndrome: a case report of a rare entity that can become a deadly threat.

Project description:BackgroundIn patients who underwent coronary artery bypass graft (CABG), the coronary-subclavian steal syndrome (CSSS) is characterized by a subclavian artery stenosis proximal to the origin of the internal mammary artery resulting in functional graft failure.Case summaryA 62-year-old gentleman underwent CABG following a non-ST elevation myocardial infarction and an angiogram showing left main stem and three-vessel disease. Forty-eight hours later he developed cardiogenic shock that improved with inotropic support and intra-aortic balloon pump insertion. However, 7 days later, he deteriorated again and even though the myocardial injury markers and echocardiogram were normal, an angiography was performed showing significant CSSS. Due to the chronic nature of his subclavian stenosis and the severity of the cardiogenic shock, the heart team decided to treated his epicardial disease percutaneously and occlude the left internal mammary artery in its mid-segment with coils. The patient was discharged home 28 days after CABG and has remained since asymptomatic with improvement in his functional class.DiscussionCoronary-subclavian steal syndrome is a rare but fatal complication with increased morbidity and mortality due to reduced awareness amongst medical professionals. Subclavian artery stenosis stenting is the gold standard treatment; herein we present a new approach for complex and very sick patients in whom it is not possible to open the subclavian artery percutaneously. Increased awareness and prompt diagnosis of this pathology in CABG patients are essential for successful outcomes.

| S-EPMC9851414 | biostudies-literature

Surgical outcomes of subclavian steal syndrome combined with carotid artery stenosis: A single-center retrospective observational study.

Project description:ObjectiveTo explore the prevalence and risk factors of carotid artery (CA) stenosis among subclavian steal syndrome (SSS) patients and to record their prognoses.MethodsThis observational study was retrospective. From January 2015 to October 2022, 169 patients were diagnosed with SSS. Among them, 51 combined with CA stenosis have surgical indications for both diseases. In this cohort, 24 were treated for subclavian artery (23 endovascular, 1 open), 12 for CA (6 endovascular, 6 open), and 5 for both (1 endovascular, 1 open, 3 hybrid). The primary end point was mortality, and the secondary end points were vessel re-stenosis and other complications. Patients were followed up through outpatient, online, or telephone.ResultsCompared with simple SSS, patients who suffered from both were older (60.51 ± 9.304 versus 66.69 ± 7.921, P < 0.001) and more males (57.6% versus 86.3%, P < .001). Besides, they presented a higher prevalence of hyperhomocysteinemia (P = .015), diabetes mellitus (P = .036), and CVA/TIA (P = .036). No patient died within 30 days after surgery; four complications occurred (1 stroke, 1 hearing loss, 1 TIA, 1 infection). During a median follow-up of 37.6 months, two patients died without relation to the operation, three appeared in-stent restenosis, and one developed contrast nephropathy.DiscussionThis study observed and analyzed different intervention methods and their prognosis in SSS combined with CA stenosis patients, and due to the limited number of participants, more data support would be needed.ConclusionsThe management of SSS patients combined with CA stenosis is more challenging compared to simple SSS. Our research demonstrated different surgical methods and their prognosis.

| S-EPMC11758550 | biostudies-literature

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