Subclavian Steal Syndrome with or without Arterial Stenosis: A Review

Abstract

The subclavian-vertebral artery steal syndrome (SSS) is the hemodynamic phenomenon of blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal subclavian artery or the innominate artery. Occasionally, SSS is diagnosed in patients not harboring arterial stenosis. With the exception of arterial congenital malformations, the limited case reports of SSS with intact subclavian artery are attributed to dialysis arteriovenous fistulas (AVFs). Interestingly, these cases are more frequently symptomatic than those with the classical atherosclerotic SSS forms. On the other hand, the disclosure of SSS due to subclavian/innominate artery atherosclerotic stenosis, even in the absence of accompanying symptoms, should prompt a thorough cardiovascular work-up for the early detection of coexisting coronary, carotid, or peripheral artery disease. Herein, we review the incidence, clinical presentation, sonographic findings, and therapeutic interventions related to SSS with and without subclavian/innominate artery stenosis. We also review the currently available data in the literature regarding the association of SSS and dialysis AVF. In addition, we present a patient with bilateral symptomatic SSS as the result of an arteriovenous graft (AVG) that was introduced after the preexisting AVF in the contralateral arm became nonfunctional. SSS due to subclavian or innominate artery stenosis/occlusion is rarely symptomatic warranting interventional treatment. In contrast, when it is attributed to AVF, surgical correction is frequently necessary.

A Rare Intracerebral Collateral Circulation Pathway from the Contralateral Vertebral Artery to the Ipsilateral Posterior Inferior Cerebellar Artery-V4 Segment Steal

“…It has been suggested that the term "vascular steal syndrome" be used only when diversion of ow is accompanied by symptoms of de cient circulation and that "steal phenomenon" or "steal effect" be used when the steal is asymptomatic (17). Common arterial steal syndromes include the subclavian artery steal (18), the vertebrobasilar artery steal and the carotid artery steal (19)(20)(21). In our study, two of ve cases of new cerebral infarction were contralateral posterior circulation infarction.…”

An Interesting Observation Regarding Retrograde Vertebral Artery Flow in Patients With Dialysis Access Fistulas

“…There have been sporadic reports of reversed vertebral artery flow in patients with upper extremity dialysis access fistulas. Four published reports of subclavian steal phenomena attributed solely to high‐flow dialysis access sites were identified in the literature …”

“…A subclavian steal is characterized by retrograde flow through the vertebral artery. The usual cause is a flow‐reducing stenosis or occlusion of the subclavian artery proximal to the origin of the vertebral artery . However, there are sporadic reports in the medical literature in which the retrograde flow through the vertebral artery was associated not with decreased flow but, rather, with increased flow through the subclavian artery, such as caused by a dialysis access fistula …”

A rare case of concomitant sicca keratopathy and ipsilateral central facial palsy in Wallenberg’s dorsolateral medullary syndrome

“…The atrial septum defect with right-left shunt can give rise to paradoxical emboli when a clot migrates from the right to the left side of the heart during a Valsalva maneuver. Subclavian-vertebral artery steal syndrome (SSS) is characterized by blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal ipsilateral subclavian artery or the innominate artery [6]. It is often asymptomatic and an incidental finding, but may also result in significant vertebrobasilar ischemia presenting mostly with transient ischemic attacks [6].…”

“…Subclavian-vertebral artery steal syndrome (SSS) is characterized by blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal ipsilateral subclavian artery or the innominate artery [6]. It is often asymptomatic and an incidental finding, but may also result in significant vertebrobasilar ischemia presenting mostly with transient ischemic attacks [6]. The role of the total occlusion of the left subclavian artery with subsequent subclavian steal syndrome in the development of the right medulla oblongata infarction is part of discussion in our patient as CTA scan of the brain could only detect diffuse atherosclerosis without any obstruction or stenosis in the carotid or vertebral artery system.…”