A case of acquired right-sided subclavian steal syndrome successfully treated with stenting using brachial approach

Subclavian steal syndrome (SSS) is defined as a group of symptoms that arise from reversed blood flow in the ipsilateral vertebral artery. It is the consequence of proximal occlusion or high-grade stenosis of the subclavian artery. The subclavian obstructive lesions are mostly located in the proximal segment of the subclavian artery and predominantly on the left side. In contrast, there are only a small number of patients that present with right-sided symptoms and even fewer with bilateral symptoms. Endovascular therapy of occlusions and high-grade stenosis of subclavian artery proximal to the origin of the vertebral artery becomes an established therapy in last two decades. We report a case of successful endovascular treatment of right-sided subclavian steal and high-grade (80%) right subclavian artery stenosis due to atherosclerotic occlusive disease with balloon-expandable stent using brachial approach.

Unusual presentation of granulomatosis with polyangiitis causing periaortitis and consequent subclavian steal syndrome:A case report

BACKGROUND Granulomatosis with polyangiitis(GPA)is a rare autoimmune disease that involves small-to-medium-sized vessels and forms necrotizing vasculitis with granulomatous inflammation.The formation of a large vessel lesion in GPA patients has been scarcely reported,and it can cause confusion in the diagnosis.CASE SUMMARY A 27-year-old man presented with mild left-sided pleuritic chest pain that started one year prior.An imaging study revealed up to 2.5 cm-sized two irregular nodular consolidation nodule in the left lower lobe.Both nodules showed central necrosis.Also,there was a periaortic mass occluding the branching porting of the subclavian artery.He had positive anti-neutrophil cytoplasmic antibodies(ANCAs),but myeloperoxidase-ANCAs and proteinase 3-ANCAs were negative.The patient also developed symptoms of subclavian vein syndrome during the follow-up.Wedge resection of the lung revealed necrotizing vasculitis,destructive parenchymal abscess and surrounding granuloma,and therefore diagnosed of GPA.The patient started on methotrexate and steroid therapy with a relief of symptomatic.CONCLUSION Here,we present an unusual manifestation of GPA with periaortitis and consequent subclavian steal syndrome,which has never been previously described.This case alerts us that we should include GPA in the differential diagnosis of large vessel vasculitis as well as subclavian steal syndrome.

Subclavian steal syndrome associated with Sjogren's syndrome: A case report

BACKGROUND Subclavian steal syndrome(SSS)caused by Sjogren's syndrome is rare,especially for elderly patients with risk factors for atherosclerosis.The current report presents the uncommon etiology and treatment of SSS,aiming to improve doctor’s clinical experience.CASE SUMMARY A 69-year-old man was diagnosed with hypertension and acute cerebral infarction presenting with left upper limb weakness and pain even gradually aggravating to left limb hemiplegia 30 years ago.He was managed with antihypertensive and antithrombotic therapy;however,his condition was recurrent,and he never had any further examination.It was found that the difference of the bilateral upper arm systolic pressure was over 20 mmHg,and Doppler examination showed that the blood flow of the left vertebral artery was reversed,suggesting SSS.Further tests revealed a benign lymphoepithelial lesion in salivary gland tissue,confirming the Sjogren's syndrome.CONCLUSION The patient was found to have hypertension when he was 33 years old,and the blood pressure of both sides was asymmetric,which was ignored.The patient's symptoms of dizziness and upper limb weakness were misdiagnosed as general cerebral infarction.It is necessary to test the aorta computed tomography angiography to prove secondary hypertension factors such as Sjogren's syndrome.

Hemodynamic evaluation of contralateral vertebral artery in patients with subclavian steal syndrome by carotid ultrasound

Objective:To investigate the ultrasonographic characteristics of the hemodynamic changes of the contralateral vertebral artery(VA)in patients with different types of subclavian steal syndrome(SSS).Methods:A total of 152 cases of SSS diagnosed by carotid Doppler ultrasonography(CDU)and confirmed by CT angiography(CTA)were enrolled as the study group.The 152 cases of SSS were divided into type Ⅰ(47 cases of occult steal blood),type Ⅱ(60 cases of partial steal blood)and type Ⅲ(45 cases of complete steal blood).Meanwhile,46 cases of cardiovascular and cerebrovascular diseases were excluded from the health examination center as the control group.The diameter and hemodynamic changes of VA in healthy side of patients with different types of steal blood were analyzed and compared with the control group.Results:The hemodynamic parameters of VA on the contralateral side of three types of SSS in the study group were compared with those in the control group,there was no significant difference between type Ⅰ and the control group(P>0.05),and there was significant difference between type Ⅱ and type Ⅲ and the control group(P<0.05);The diameter and hemodynamic parameters of VA increased with the severity of steal blood(P<0.05).Conclusion:CDU examination of VA hemodynamic parameters in healthy side of SSS patients can be used to preliminarily evaluate SA lesions and VA-VA steal pathway.

Coronary subclavian steal syndrome

Coronary subclavian steal syndrome arises when a stenosis of the subclavian artery results in reduced antegrade or retrograde flow in an internal mammary artery with resultant coronary ischemia.……

A rare case of non-ST-segment elevation myocardial infarction triggered by coronary subclavian steal syndrome

Coronary subclavian steal syndrome (CSSS) has been recognized lately as an unusual clinical entity,giving rise to angina but rarely causing an acute coronary syndrome (ACS). The prerequisites for the appearance of CSSS are both a patent left internal mammary artery (LIMA) graft and severe stenosis of the left subclavian artery (LSA). However,LSA is often overlooked in the diagnostic evaluation of patients with angina,who have underwent coronary artery bypass grafting (CABG). We report an unusual case of non-ST-segment elevation myocardial infarction (NSTEMI) caused by subtotal occlusion of proximal LSA.

Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome: A case report

BACKGROUND We report a rare case of numbness in the right hand,finally diagnosed as bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome and explain the cause of these diseases.CASE SUMMARY The patient was a 65-year-old woman.She complained of dizziness,numbness and weakness of the right hand for 6 mo.She was diagnosed with bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome by ultrasound,enhanced computed tomography,computed tomography angiography and other examinations.Considering the surgical risks,the patient refused the aberrant right subclavian artery stent implantation and was discharged.We hypothesize that these two kinds of deformity and right subclavian steal syndrome may not occur by accident and result from multiple malformations.CONCLUSION Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome is rare.This case reminds interventional radiologists of the possibility of these abnormalities before surgery.

Subclavian Steal Syndrome: a Report of 25 Cases

F1982 to 1992,25 patients with subclavian steal syndrome were admitted;20 cases had undergone surgery.The etiology inluded atherosclerosis in 14 cases(56%),Takayasu’s disease 9 cases(36%);14 cases was smokers.

Carotid to subclavian bypass, rare but rewarding surgery: A case report

Different treatment options are available for subclavian stenosis(SS).Carotid to subclavian bypass surgery(CSBS)is an increasingly used effective treatment strategy when stenting is impossible.However,in Nepal,little is known about SS and its management.A 58-year-old man with a history of aortic valve replacement surgery complained of progressive left arm weakness for the past 6 months associated with pain on exertion and blood pressure discrepancies in both arms.A computed tomographic scan confirmed near-complete subclavian artery stenosis and a Doppler ultrasound showed decreased bloodflow and systolic velocity.CSBS was selected as stenting was not feasible.Post-CSBS,all hemodynamic parameters returned to normal,lasting even after 2 years.CSBS appears to be a viable,safe,and promising treatment for symptomatic SS.However,additional studies need to be conducted to analyze the benefits of CSBS relative to other interventions.

Subclavian artery stenting via bilateral radial artery access:Four case reports

BACKGROUND Subclavian artery stenosis refers to the stenosis in the lumen caused by the presence of plaque or thrombus in the subclavian artery.It is a common problem in endovascular interventions.In fact,conventional subclavian artery stenting via the femoral artery approach is effective and safe.Nevertheless,because femoral artery puncture is not easy to stop bleeding,it requires longer femoral artery compression or more expensive hemostatic materials,such as staplers.Patients need to be catheterized and bedridden for a longer time,which may lead to many complications,such as pseudoaneurysm.CASE SUMMARY Herein,we reported a new interventional therapy of subclavian artery.From March 1,2020 to August 31,2021,we operated on four patients with subclavian artery stenting via bilateral radial artery access.CONCLUSION After reviewing four cases of successful placement of clavicular artery stents via bilateral radial arteries,we concluded that bilateral radial artery approach is feasible.Clavicular artery stenting is safe,effective,and timesaving.It is an excellent alternative to the traditional femoral artery procedure,with few complications and high comfort degree.

颅外段颈部动脉粥样硬化性疾病外科治疗京津冀专家共识

颅外段颈部动脉粥样硬化性疾病是最常见的脑血管病类型,外科治疗是降低患者致残率和死亡率的重要手段。天津市医学会神经外科学分会牵头组织京津冀专家结合近年来我国的临床实践和国内外相关的循证医学证据,制订了该共识。该共识对颅外段颈部动脉粥样硬化性疾病危险人群的筛查、危险因素控制、外科治疗方案以及围手术期管理等进行了总结,旨在为我国颈部动脉粥样硬化性疾病的临床治疗提供循证的规范性指导。

血管内治疗以头晕起病的锁骨下动脉盗血综合征24例并文献复习

目的探讨头晕起病的锁骨下动脉盗血综合征(SSS)的临床特征、血管内治疗方案、效果及注意事项。方法回顾北京大学首钢医院2021年7月至2023年1月收治的头晕起病的24例SSS患者的一般特征、临床表现、经颅多普勒超声(TCD)、头颈CT血管造影成像(CTA)、数字减影血管造影成像(DSA)等相关临床资料数据及其锁骨下动脉内治疗情况,分析血管内支架置入的治疗效果。复习相关文献,以提高对SSS的识别及诊断治疗经验。结果24例患者中左侧锁骨下动脉重度狭窄13例,左侧锁骨下动脉闭塞2例,右侧锁骨下动脉重度狭窄9例,成功置入病变处23枚支架,术中造影可见椎动脉恢复正向血流,术后患侧上肢脉搏、血压恢复,患者头晕改善,复查TCD未再出现锁骨下动脉盗血现象。血管内治疗失败1例,究其原因与患者既往主动脉弓覆膜支架介入治疗相关。结论以头晕为临床表现的锁骨下动脉狭窄,常提示锁骨下动脉盗血。锁骨下动脉支架置入治疗SSS能快速有效缓解临床症状且安全有效。

无椎动脉反流的锁骨下动脉窃血综合征的彩色多普勒超声表现分析

目的 分析锁骨下动脉窃血综合征 (SSS)的病因 ,血流动力学改变 ,超声表现以及合并其他颈部血管严重病变时的血流动力学改变及其与窃血的关系。方法 分析本院经超声检查并经临床确诊锁骨下动脉或无名动脉起始段重度狭窄或闭塞的患者 49例。结果 锁骨下动脉窃血综合征主要由动脉粥样硬化和多发性大动脉炎所致。结论 当锁骨下动脉或无名动脉起始段病变 ,合并颈部其他血管严重病变时 ,不应单纯依靠椎动脉的血流方向来估测同侧锁骨下动脉或无名动脉的狭窄情况。

高频彩超诊断锁骨下动脉盗血综合征的价值

目的探讨高频彩超诊断锁骨下动脉盗血综合征的价值及扫查技巧。方法回顾性分析我院彩超检出的13例锁骨下动脉盗血综合征患者资料,用普通高频探头重点探测椎动脉血流方向及频谱特征,将其分为三型:隐匿型(椎动脉频谱收缩期出现切迹)、部分型(椎动脉频谱收缩期出现逆向血流)、完全型(椎动脉频谱完全呈逆向血流)。用高频小体积颅脑探头重点探测锁骨下动脉起始段,测量峰值血流速度。结果超声提示隐匿型4例(占30.8%,其中2例与临床符合,2例不符)、部分型5例(占38.5%)、完全型4例(占31.8%),超声诊断符合11例(占84.6%)、误诊2例(占15.4%,均为隐匿型)。除锁骨下动脉闭塞两例峰速为0外,其余所有患者均出现程度不同的锁骨下动脉峰值流速增高。结论注重椎动脉频谱特征性改变,有利于早期诊断锁骨下动脉盗血综合征;用高频颅脑小探头探查锁骨下动脉起始段,能准确测得锁骨下动脉狭窄处峰值血流速度,从而减少误诊。高频彩超诊断锁骨下动脉盗血综合征,价值确切。

64层螺旋CT血管成像与数字减影血管造影在锁骨下动脉盗血综合征诊断中的价值

目的通过与数字减影血管造影(DSA)对比,评价64层螺旋CT血管成像(CTA)在锁骨下动脉盗血综合征诊断中的应用价值。方法选择锁骨下动脉盗血综合征患者24例行CTA和DSA检查,在CT工作站对锁骨下动脉和无名动脉进行曲面重建、最大密度投影及容积再现后处理,并与DSA结果对照。结果 24例CTA显示共72支锁骨下动脉和无名动脉,25支血管存在狭窄性病变,重度狭窄18支,完全闭塞7支。CTA诊断血管低估1支,高估0支。以DSA检出血管狭窄程度≥70%为阈值,CTA对狭窄程度诊断的敏感性96.0%,特异性100%,准确率98.6%,阳性预测值100%,阴性预测值97.9%。根据CTA检查结果行单纯经皮血管球囊成形术4例,同时行支架置入20例,共21枚。结论 64层螺旋CTA是评估锁骨下动脉和无名动脉狭窄或闭塞的可靠方法,可作为锁骨下动脉盗血综合征术前评价的首选检查,为临床选择介入治疗方案提供依据。

锁骨下动脉盗血综合征的经颅多普勒和血管造影分析

用经颅多普勒超声（ＴＣＤ）和血管造影（ＤＳＡ）检查了１３例锁骨下动脉盗血综合征病人，ＴＣＤ发现１１例有椎动脉血流反向，肢体功能试验时反向血流增加。２例血流方向正常，功能试验血流方向倒转或血流速度下降。１例无名动脉狭窄，右侧椎动脉和颈总动脉均受累，出现大脑中动脉盗血。ＤＳＡ显承５４％的病人有反向血流。提示椎动脉反向血流与锁骨下动脉狭窄程度和侧支循环建立程度有关。２５％同时合并大脑中动脉狭窄。ＴＣＤ是观察椎动脉、基底动脉、大脑中动脉盗血的敏感方法，可帮助判断其对大脑半球血液供应的影响。

锁骨下动脉窃血综合征椎动脉多普勒频谱特征与锁骨下动脉狭窄的关系

目的分析锁骨下动脉窃血综合征椎动脉血流频谱特征及血流速度与锁骨下动脉狭窄程度的关系。方法将50例确诊的锁骨下动脉窃血综合征患者按锁骨下动脉狭窄程度分为3组,分析患者椎动脉血流频谱特征及收缩期血流速度,比较各组间上述指标的差异。结果①椎动脉Ⅰ度窃血多普勒频谱主要表现为收缩中晚期流速下降;椎动脉Ⅱ度窃血主要表现为收缩期血流反向;椎动脉Ⅲ度窃血主要表现为收缩期和舒张期血流均反向。②与轻中度狭窄组比较,锁骨下动脉重度狭窄组及闭塞组患侧椎动脉收缩期峰值流速减低,且以闭塞组更为明显;与轻中度狭窄组比较,锁骨下动脉重度狭窄组及闭塞组健侧椎动脉收缩期峰值流速增加。结论患侧椎动脉多普勒血流频谱特征及收缩期峰值流速可以间接反应锁骨下动脉狭窄程度。

锁骨下动脉盗血综合征的彩色多普勒血流显像分析

目的 分析比较 2 7例锁骨下动脉盗血综合征 (SSS)患者锁骨下动脉、椎动脉和桡动脉的血流动力学、频谱特点 ,以及狭窄程度与盗血的关系等。方法 2 7例患者均经临床检查、超声诊断以及相关检查确诊。彩色多普勒超声常规显示颈动脉、椎动脉、桡动脉、锁骨下动脉及无名动脉的内径、内膜和血流方向及速度。结果 2 7例患者中 ,锁骨下动脉狭窄18例 ,内径 1.0～ 4.4mm ,血流速度 10 0～ 42 0cm /s ;9例锁骨下动脉闭塞 ,均引起完全性盗血。椎动脉及桡动脉峰值血流速度患侧明显低于健侧 ,患侧椎动脉出现反向血流 ,桡动脉血流与锁骨下动脉狭窄程度和反向椎动脉血流有一定关系。结论 彩色多普勒血流显像 (CDFI)可对完全性SSS做出诊断 ,部分性SSS可辅助于脉冲多普勒和束臂试验明确诊断。完全性和部分性盗血与血管狭窄程度有关。患侧椎动脉反向血流和桡动脉峰值血流速度取决于侧支循环建立的完善与否。

锁骨下动脉完全性闭塞的血管内治疗

目的讨论锁骨下动脉完全性闭塞介入治疗方法的可行性、安全性和有效性。方法对28例锁骨下动脉(28支)近端完全闭塞合并有椎-基底动脉供血不足和(或)上肢缺血症状患者进行回顾性分析。其中男20例,女8例;年龄为42～76岁,平均为56岁。根据DSA显示闭塞段形态,应用导丝开通、球囊扩张及支架置入的方法进行治疗。经股动脉穿刺为顺行方式,经病变的股动脉和桡动脉穿刺为逆行方式。结果通过顺行方式开通19例,逆行开通9例。25例开通成功并置入自膨式支架,失败3例,成功率为89%(25/28);25例患者置入支架后,症状、体征明显改善。患者双上肢收缩压差由术前>20mm Hg,恢复至术后<10 mm Hg;术后TCD显示,椎动脉血流均由逆向转为正向。25例成功置入支架患者中,术后随访23例,失访2例,随访时间为2～48个月,平均24个月。有2例分别于术后12个月和15个月时出现支架内再狭窄,再次予以球囊扩张术和支架置入术,取得满意疗效。结论掌握好适应证,血管内机械性再通及支架置入术治疗锁骨下动脉闭塞是一种安全、可行、有效的方法 。

椎动脉起始部合并相邻锁骨下动脉重度狭窄支架置入的治疗

目的探讨对椎动脉起始部及相邻锁骨下动脉重度狭窄患者同时置入支架的疗效。方法在18例患者椎动脉起始部狭窄处置入球囊扩张式支架,并在相邻的锁骨下动脉狭窄处释放自膨式支架,两枚支架成T形。操作方法：采用Seldinger技术,将8F导引导管置于锁骨下动脉狭窄的近段,用0.014微导丝,通过椎动脉狭窄段,到达椎动脉远段;同时将0.018导丝通过锁骨下动脉狭窄处;然后沿着0.018导丝将球囊送到锁骨下动脉狭窄处预扩张,沿着0.014导丝,将球囊扩张支架送至椎动脉起始部狭窄处后小心释放;再沿着0.018导丝将自膨式支架送达锁骨下动脉狭窄处释放。术后3～12个月行TCD复查16例。结果14例锁骨下动脉支架术后血流通畅,椎动脉起始部支架术后血流通畅,2例锁骨下动脉支架术后血流通畅,椎动脉起始部支架术后血流速度增快,考虑椎动脉起始部支架再狭窄。术后患者的术前症状好转或消失15例,2例自觉症状无变化,1例术后24h突然出现眩晕、呕吐、声音嘶哑、吞咽困难,患侧有Horner征,面部疼痛、温觉减退,患侧共济失调。结论对椎动脉起始部及相邻锁骨下动脉重度狭窄的患者,通过同时置入支架进行血管内治疗,恢复正常血流,是较为安全、有效的治疗方法。