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. KEYWORDS: subclavian steal, angiography, atherosclerosis. CASE REPORT:A 60 year old female, a known hypertensive on medication, was admitted for evaluation of severe headache of 2 weeks duration, with mild tingling sensation in her left arm. The patient denied any history of chest pain, palpitation, visual changes, aura, nausea, fever or upper respiratory discharge.Her medical history included long standing hypertension with hypercholesterolemia, and past history of left basal ganglia infarct.On physical examination, her blood pressure was 140/90 mmHg (right arm), left radial pulse was feeble, following which BP was recorded in the left arm which was found to be markedly low at 80/44 mmHg. Other clinical findings, laboratory investigations, ECG and chest X-ray were unremarkable. CT brain showed a chronic infarct in the left basal ganglia. With the clinical suspicion of vertebral steal syndrome, the patient was referred for Doppler evaluation of the neck vessels.Doppler study showed complete reversal of the blood flow in the left vertebral artery, both in systole and diastole (type 4 waveform) (Fig. 1); monophasic low velocity flow in the distal left subclavian artery; a non-occlusive soft plaque in the right carotid bulb and left internal jugular vein thrombosis. The proximal left subclavian artery was not accessible for the study. The findings were suggestive of Complete/Stage III subclavian steal syndrome and MDCT angiography of the neck vessels was advised.MDCT angiography was performed following contrast injection, which showed irregular concentric wall thickening of the left subclavian artery near origin causing complete luminal stenosis. Bilateral vertebral arteries and the left subclavian artery distal to the origin of the Left Vertebral artery showed normal luminal opacification with contrast (Fig. 2), suggesting the feeding of distal left subclavian artery by the left vertebral artery. The left internal jugular vein thrombosis was also demonstrated. The findings were conclusive of subclavian steal syndrome secondary to occlusion of proximal left subclavian artery due to atherosclerosis. DISCUSSION:Subclavian steal syndrome is relatively rare condition. Two times more common in females than in males, and patients are generally of the elderly age group. [1][2] Subclavian steal syndrome occurs when the subclavian artery, most commonly the left, becomes occluded proximal to the origin of the vertebral artery. In this setting, the distal subclavian artery "steals" blood from the
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