Abstract. Subclavian steal syndrome (SSS) is a condition characterized by a steno-occlusive impairment of the proximal subclavian artery. The majority of patients with SSS are asymptomatic, while symptomatic patients present with neurological symptoms. SSS is a risk factor for cerebral ischemia, which reacts badly upon cognitive function; however, it remains unknown whether SSS is able to cause progressive cognitive impairment. In the present study, the potential effects of SSS on cognitive function were investigated using atherosclerotic rabbits as a model of SSS. A total of 48 male New Zealand rabbits were divided into the control, sham and SSS groups. The results of eyeblink experiments indicated no significant differences among the three groups; however, SSS did appear to exert a negative impact on neurogenesis in the cerebellar cortex. In order to further clarify the mechanisms underlying this SSS-mediated reduction in cell proliferation, the energy metabolism, immune function and oxidative stress statuses were evaluated by determining the levels of adenosine triphosphate (ATP), adenosine, interleukin (IL)-1β, IL-6, malondialdehyde, 8-hydroxy-2'-deoxyguanosine, CuZn-superoxide dismutase and catalase. The results showed that the levels of extracellular ATP in the cerebellar cortex had decreased, while levels of adenosine had also decreased. These findings suggest that SSS is able to inhibit neurogenesis in the cerebellar cortex by decreasing the extracellular ATP levels. Furthermore, these changes may result in an impairment of the cognition of the rabbits. The early diagnosis and treatment of SSS may, therefore, prevent or mitigate cognitive impairment in the future.
IntroductionSubclavian steal syndrome (SSS) is a condition characterized by a steno-occlusive impairment of the proximal subclavian artery (SA). SSS is most frequently observed in Caucasians aged >50 years, due to the increased incidence of atherosclerosis in this population. SSS causes reversal flow in the ipsilateral vertebral artery (VA) away from the brainstem, resulting in vertebrobasilar insufficiency (1). The primary cause of SSS is atherosclerosis. The majority of patients with SSS are asymptomatic, while symptomatic patients present with neurological symptoms, including light-headedness, ataxia, vertigo, dizziness, hearing loss, confusion, headache, nystagmus, visual disturbances, focal seizures and presyncope (2-4).Treatment of SSS remains controversial (5). Since the majority of patients with SSS are asymptomatic, there has been debate as to the necessity of conducting early treatment. Alcocer et al (6) recommended that patients presenting with low symptomatology or non-life threatening symptoms be treated with a conventional approach; however, Sharma et al (7) suggested that SSS-induced chronic brainstem hypoperfusion could lead to a gradual slowing of speech and gait in patients and that early diagnosis and treatment could result in an improved quality of life. Notably, SSS is a risk factor for cerebral ischemia, which may negative...