Clinical and hemodynamic significance of innominate artery lesions evaluated by ultrasonography and digital angiography.

Abstract

To determine the hemodynamic and clinical consequences of an atherosclerotic obstructive lesion of the innominate artery on the cerebral circulation, 20 patients with an innominate artery lesion underwent neurologic examination and ultrasonic duplex scanning before and after right arm exercise. The patients were divided into two groups: Group 1, 12 patients with 40-80% stenosis and Group 2, eight patients with 80-100% stenosis. A significant difference between the groups was noted in both the hemodynamic and clinical manifestations. All 12 Group 1 patients compensated for the increased demand for blood of the right arm through the innominate artery itself, and only one showed symptoms of vertebrobasilar insufficiency associated with right arm exercise. In all eight Group 2 patients, compensation through the innominate artery failed; six (75%) showed symptoms of vertebrobasilar insufficiency after exercise. Dynamic duplex scanning is well suited to investigate stenotic lesions of the innominate artery, the effects of arm exercise on the development of cerebral symptoms, and the source of blood flow to the arm. Dynamic duplex scanning proved to be useful in selecting patients who may be candidates for direct arterial surgery. (Stroke 1988;19:958-962)

Recurrent pulmonary edema induced by coronary-subclavian steal syndrome during hemodialysis

“…All patients who have received therapy for CSS need close follow-up. Regular Duplex examination before and after arm exercise can detect recurrent stenosis, with a high degree of accuracy [10].…”

Influence of the Basilar Artery Blood Flow on Vertebrobasilar Ischaemia in the Subclavian Steal Phenomenon: A Transcranial Doppler Study

“…finally, the direction of blood flow in the basilar artery can be determined. These tests provide a more precise assessment and under standing of the complex haemodynamic consequences of a lesion of the brachiocephalic arteries for the cerebral cir culation [2][3][4]. In our opinion, in combination with a neu rological examination, these tests can be useful in the ini tial and serial evaluation of patients with a subclavian steal phenomenon, and in the assessment of pathological processes and subsequent interventions.…”

“…Usually in this situa tion, blood is siphoned from the contralateral vertebral artery via the ipsilateral vertebral artery into the subclav ian artery distal to the stenosis. However, if the contralat eral vertebral artery is hypoplastic or has a severe stenosis, a carotid-basilar collateral circulation with reversed or decreased blood flow in the basilar artery can develop [3,4], The cardinal signs and symptoms of subclavian artery stenosis and steal arc related to ischaemia of the arm. The neurological symptomatology is most likely due to re duced anterograde flow to the brain stem, cerebellum, and occipital lobes.…”

Floating Thrombus in the Innominate Artery as a Cause of Cerebral Infarction in Young Adults

“…Atherosclerotic stenosis or occlusion of the innominate artery may uncommoncly cause symptoms, mainly in relation to hemodynamic disturbances [1,2], We arc not aware of any report on stroke patients with evidence for intraluminal thrombus at that level. We report two young women who suffered an embolic cerebral infarction in the territory' of the middle cerebral artery' (MCA) from a float ing thrombus in the innominate artery.…”

“…The difference in blood pressure between both arms (as in patient I) and the absence of right carotid, radial, ulnar and brachial pulses (both patients) in a patient with acute stroke suggest an underlying stenosis of the innominate artery. Careful aor tic arch angiography and probably new ultrasound tech niques [1,2] may aid in the diagnostic workup.…”