Diagnosis and management of unilateral subclavian steal syndrome with bilateral carotid artery stenosis

Abstract

Subclavian steal syndrome is a rare phenomenon occurring from retrograde blood flow in the vertebral artery due to proximal stenosis in the subclavian artery. As a result, the arm gets blood supply from the vertebral artery at the expense of the vertebrobasilar system. The patient remains largely asymptomatic until there is an increase demand for blood supply to the arm, resulting in a constellation of symptoms including dizziness, vertigo, blurred vision, diplopia, headache, syncope, postural hypotension, neurologic deficits, and rarely, memory problems. The management approach depends on the severity of clinical symptoms but includes medical treatment, endovascular therapy and lifestyle modifications.

Anesthetic management of a patient with bilateral subclavian artery stenosis undergoing lower extremity arterial thrombectomy

“…Inadequate blood supply due to subclavian artery stenosis [11] . The main symptoms include dizziness, vertigo, syncope, ataxia, imbalance, falls, diplopia, nystagmus, hemianopsia, blurred vision, tinnitus, hearing loss, bilateral arm muscle weakness, and others [12] .…”

Subclavian Artery Calcification: A Narrative Review

“…According to Kablak-Ziembicka, PTA is a straightforward procedure with faster recovery times compared to CABG [20]. A 3.6% combined stroke and death complication rate has been noted for PTA [31]. Balloon stenting alongside PTA has been found to decrease stenosis recurrence (P = 0.004, 95% CI) [38].…”

“…Management options of SAC and stenosis are summarized in Tables 1, 2. Guidelines of 2018, percutaneous balloon stenting was the preferred method of management for patients with SSS [31]. Patients with SSS could be symptomatic or asymptomatic.…”

“…Patients with SSS could be symptomatic or asymptomatic. Symptoms are often described as syncope, arm claudication, and dizziness due to a difference of >15 mmHg in systolic blood pressure [31].…”

“…Percutaneous balloon stenting is a preferred mode of managing patients with SSS as the combined treatment provides long-term patency rates as well as reduces the chances of restenosis occurrence [29,30]. According to the guidelines issued by the European Society of Cardiology in 2018 as well as studies conducted by Chatterjee et al, percutaneous balloon stenting is a favorable option for managing symptomatic as well as asymptomatic patients with SSS [30,31]. Symptoms of SSS include intermittent pain in the upper limbs, PP discrepancies in both arms as well as neurological manifestations such as lightheadedness and syncope [11,32].…”