Carotid steal syndrome following carotid subclavian bypass

Abstract

Subclavian steal syndrome may result from stenosis or occlusion of the subclavian artery proximal to the origin of the vertebral artery. The diagnosis can be confirmed by noninvasive vascular studies with the use of a directional Doppler probe or by time-sequence aortic arch angiography, both of which can detect retrograde flow in the vertebral artery. A variety of surgical approaches to this condition have been used in the past, but the simpler and much safer carotid-to-subclavian bypass has become a more acceptable surgical procedure. There remains, however, a theoretical possibility that blood may be siphoned from the intracranial arteries perfused by the carotid. This phenomenon, which may be called the carotid steal syndrome, has been discussed, but no clinical cases have been reported. We present a patient who developed such a carotid steal syndrome 2 years after left carotid-subclavian bypass. This occurrence reemphasizes the importance of determining a normal carotid bifurcation prior to performing carotid-subclavian bypass.

Subclavian carotid transposition and bypass grafting: Consecutive cohort study and systematic review

“…22 A reduction in blood flow in the carotid artery after CSB has been observed in animal models. [23][24][25] Only three cases of clinically significant carotid steal, however, were reported, two after CSB 26,27 and one after a carotid-axillary bypass grafting procedure. 28 In patients undergoing an SCT, Sandman 21 was unable to identify hemodynamic evidence of carotid steal with Doppler ultrasound scanning during surgery.…”

Acute subclavian artery occlusion with associated clavicle fracture managed with bypass graft alone

“…The 5-year patency rates for such bypass procedures are approximately 90% 16. Carotid steal syndrome is a rare consequence of such a procedure 17. The disadvantage of bypass techniques are inadequate visualisation of the injured artery and inability remove bone fragments that further arterial injury.…”

Long-term results and outcomes of crossover axilloaxillary bypass grafting: A 24-year experience

“…38,39 Carotid-subclavian bypass grafting procedures have extremely low mortality rates (1.9%) and optimal primary patency rates (95%). [40][41][42] However, several authors [43][44][45][46][47] have criticized this reconstruction and proposed the subclavian-carotid transposition. Subclavian-carotid transposition offers some advantages over carotid-subclavian bypass grafting, such as the avoidance of prosthetic materials, which thus annuls the risk of infection (0.0% vs 1.5%), 41 and the decrease of myointimal hyperplasia formation because of the similar vessel diameters.…”