Right subclavian double steal syndrome: a case report

Abstract

IntroductionDouble-steal syndrome represents a causative factor for blood flow compromise of the cerebral vascular bed with transient neurologic symptoms. We present the case of a patient with innominate artery atherosclerotic occlusion, manifested as blood flow reversal in the vertebral and common carotid arteries. Symptomatic atherosclerotic occlusive disease of the innominate artery is relatively rare and represents less than 2% of all extracranial causes of cerebrovascular insufficiency.Case presentationWe report on a 73-year-old male patient who presented at our hospital for the evaluation of dizziness and episodes of syncope. Angiography and color Doppler examinations documented the double syndrome as retrograde flow in the right vertebral artery and the right carotid artery.ConclusionConstituting an indication for surgical correction, his condition was managed with the performance of carotid-carotid extra-anatomic bypass for the permanent reestablishment of antegrade blood flow in the vascular network supplying the brain. Carotid-carotid extra-anatomic bypass was a good option for our patient, since he remains symptom free after one year of follow up.

The Paramount Role of the Anterior Communicating Artery in the Collateral Cerebral Circulation

“…12 On the contrary, patients with severe innominate artery (IA) disease have more significant alterations in extracranial hemodynamics, which may lead to flow compromise. [13][14][15] In patients with IA occlusion, blood "stolen" by the right vertebral artery perfuses the right carotid as well as right brachial artery -a phenomenon called "carotid recovery." During strenuous upper limb exercise or in case of inadequate collateral circulation through the vertebral artery, flow through the carotid artery may even reverse leading to a phenomenon known as "subclavian-carotid double steal.…”

Double Steal Syndrome: Two Case Presentations

“…The difference in the presentation and ultrasound findings between these two patients further demonstrates patients with severe carotiddisease and significant imaging findings may remain clinically asymptomatic due to vast collateralization. The atherosclerotic lesions form progressively while allowing collateral arterial supply to develop that aids in supply to the circle of Willis and the right upper extremity [2].…”

“…Occlusive disease of the proximal innominate trunk is relatively rare when compared to the carotid and subclavian arteries. However, stenosis of the innominateartery will decrease the inflow to the right upper extremity as well as to the right carotid which has potential to result in ipsilateral upper extremity symptoms and cerebrovascular insufficiency [2]. Many collateral supplies may develop to prevent the onset of these symptoms and the contralateral carotid and vertebral artery will continue to supply the circle of Willis preventing ischemia [2].…”

Hybrid one-stage reconstruction of the right subclavian artery occlusion and critical stenosis of the brachiocephalic trunk

“…Рис. 4 6) удаление индродьюсера из протеза, резекция избыточной части протеза с пункционным отверстием; 7) наложение дистального анастомоза между протезом ПТФЕ 8 мм и ППА по типу конец-в-бок.…”

“…[1]. Этот клинический синдром проявляется признаками и симптомами вертебро-базилярной недостаточности, но также может быть асимптомным [2][3][4].…”