Relevance of Basilar Artery Study in Patients with Subclavian Steal Phenomenon

Abstract

Abstract:A 72-year-old male presented to the emergency department with gait instability and unclear speech. Computed tomography of the brain showed old lacunar infarcts in basal ganglia. Transcranial Doppler (TCD) sonography was normal. Extracranial Duplex sonography showed indirect hemodynamic signs of bilateral subclavian artery stenosis and both vertebral arteries also showed delayed systolic flow increase. A bilateral subclavian steal phenomenon was suspected, and arm compression tests was performed. The tests promoted reverse flow in the right VA, loss of diastolic flow in the left VA and interestingly, the normal anterograde BA flow became retrograde. Although subclavian steal is likely to be an innocuous phenomenon for the majority of our patients, it is probable that the presence of a hemodynamic effect on the basilar artery may identify those who are at special risk of neurologic symptoms. So, we recommend TCD study in all patients suffering SSP to rule out the possibility of a BA steal phenomenon.

Endovascular Management of Pediatric High-Flow Vertebro-Vertebral Fistula with Reversed Basilar Artery Flow

“…Reversal of basilar artery flow is an uncommonly described entity, and indicates both very high-flow AV shunting and patent posterior communicating arteries to compensate for vertebrobasilar insufficiency [8][9][10][11]13 . Although reversed basilar flow has been associated with significant neurological symptoms in patients suffering from subclavian steal phenomenon 11 , it may be asymptomatic as in our case and emphasizes the robust collateral network often present in children. Furthermore, we have not been able to identify a prior pediatric case documenting a high grade VAVF with basilar artery flow reversal in the available medical literature.…”

“…Reversal of flow in the basilar artery is exceptionally uncommon and has been described in rare complicated cases of intracranial vertebral artery dissections 8 , vertebrobasilar occlusions 9 , giant cell arteritis 10 , bilateral subclavian steal phenomenon 11 , and post-traumatic/iatrogenic VAVFs in adults 12 . We present a unique pediatric case of a high-flow VAVF causing basilar flow reversal requiring endovascular treatment with coil embolization.…”