Are patients with subclavian steal syndrome at risk of stroke?
To determine the risk of stroke in patients with subclavian steal syndrome (SSS). We identified 165 patients with imaging-provenSSS from two hospitals. Demographic, clinical and imaging data were retrospectively collected. Patients were followed up for stroke events.
What causes subclavian steal syndrome?
Subclavian steal syndrome develops due to a blockage in or narrowing of a subclavian artery. The most common cause is atherosclerosis. Other risk factors include large artery vasculitis and congenital heart irregularities. Without treatment, some causes of subclavian steal syndrome can lead to serious complications.
Can subclavian artery stenosis cause neurological symptoms?
Subclavian artery stenosis can cause neurological symptoms. When this happens, it is called subclavian steal syndrome. The symptoms of subclavian steal syndrome are neurological. They are called “posterior circulation symptoms”. This is because the source of the symptoms are the vertebral arteries.
What causes vertebral steal from severe right proximal subclavian artery stenosis?
The following image shows the final stage of vertebral steal from severe right proximal subclavian artery stenosis: Sometimes the plaque that is causing the narrowing in the subclavian artery will also include the vertebral artery. This may result in concomitant vertebral artery stenosis.
Is subclavian steal syndrome life threatening?
People at increased risk of developing it should also take such precautions. Some causes of subclavian steal syndrome can lead to serious and even life threatening complications without treatment.
How serious is a blocked subclavian artery?
It involved obstruction of blood flow through the subclavian artery and is four times more common in the left subclavian artery than the right. It can cause significant ischemia of the brain, upper extremities, and occasionally, the heart.
How does subclavian steal affect blood pressure?
In this condition, occlusive disease in the proximal subclavian artery can lead to a siphoning of blood away from the brain by a reversal of flow down the vertebral artery on the affected side to the ischemic limb. The pulse and blood pressure are diminished in the affected limb.
What happens in subclavian steal?
The subclavian steal syndrome is characterized by a subclavian artery stenosis located proximal to the origin of the vertebral artery. In this case, the subclavian artery steals reverse-flow blood from the vertebrobasilar artery circulation to supply the arm during exertion, resulting in vertebrobasilar insufficiency.
What are the symptoms of a subclavian artery blockage?
Upper extremity symptoms include arm claudication or muscle fatigue, rest pain, and finger necrosis. Neurologic issues include vertebrobasilar hypoperfusion including visual disturbances, syncope, ataxia, vertigo, dysphasia, dysarthria, and facial sensory deficits.
What is the treatment for subclavian steal syndrome?
Stent supported angioplasty for SSS has been performed for patients with symptomatic subclavian steal syndrome. Surgical options, such as carotid-subclavian bypass, are generally reserved for patients who have failed endovascular treatment.
What artery is most commonly occluded with subclavian steal syndrome?
Background. The term subclavian steal describes retrograde blood flow in the vertebral artery associated with proximal ipsilateral subclavian artery stenosis or occlusion, usually in the setting of subclavian artery occlusion or stenosis proximal to the origin of the vertebral artery.
Does subclavian steal syndrome cause headaches?
Headache may be the only symptom of subclavian steal syndrome after thoracic endovascular aortic repair.
Is subclavian steal syndrome a disability?
A disability rating in excess of 20 percent is not warranted for arteriosclerosis, variously classified as left-sided subclavian steal syndrome with bilateral iliac disease. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.20, 4.21, 4.104, Part 4, Code 7114 (1992).
Can subclavian steal syndrome be cured?
No medical therapy is known to be capable of effectively treating subclavian steal syndrome.
What are the signs of steal syndrome?
Hemodialysis access-related hand ischemia or 'steal syndrome' causes problems such as hand numbness, pain, coldness and weakness, as well as significantly reduced blood flow/pressure to affected tissues. In extreme cases, it can cause tissue death (gangrene), which may lead to the loss of fingers.
How do you confirm subclavian steal syndrome?
CT and MR angiography are used to confirm any suspected subclavian steal cases found on ultrasound exams, because not all retrograde vertebral flow seen on ultrasound examinations constitute true subclavian steal. Some have been shown to stem from proximal vertebral artery stenosis or occlusion.
What is done for a blockage to the left subclavian artery?
Most subclavian blockages can be treated with stents, but in some cases, surgery may be needed. With surgery, blood flow is rerouted across the blockage using a small plastic tube called a bypass graft. Both stents and surgery are highly effective treatments and often help symptoms improve.
What happens if the subclavian vein is blocked?
A condition caused by repetitive arm motion This tissue causes the vein to narrow and restrict blood flow, leading to the formation of blood clots. Left untreated, axillo-subclavian vein thrombosis can cause: Arm pain and fatigue. Arm swelling.
What does subclavian artery pain feel like?
You may experience arm pain or muscle fatigue when using your arms above your head, or doing any activity that demands more oxygen-rich blood flow to the arms. Other symptoms can include: Dizziness (vertigo) with arm activity. Feeling as if you might pass out.
Can you live with a blocked artery?
We can sometimes go around the blockage or work backward through the heart. We're now seeing success rates of 90% to 95%. If you are told that you have an artery that is 100% blocked, it's important to know that it can be treated.
Why is subclavian steal not a cause of lifestyle changes?from medicalnewstoday.com
This is because in most cases, the cause is atherosclerosis.
What causes subclavian steal syndrome?from medicalnewstoday.com
Subclavian steal syndrome develops due to a blockage in or narrowing of a subclavian artery. The most common cause is atherosclerosis. Other risk factors include large artery vasculitis and congenital heart irregularities.
What are the risk factors for subclavian steal?from medicalnewstoday.com
Other possible risk factors for subclavian steal syndrome include: large artery vasculitis, which is the medical term for inflammation of the large arteries. thoracic outlet syndrome, which is a group of conditions that occur when the blood vessels or nerves between the collarbone and first rib become compressed.
Why is my subclavian artery narrowing?from medicalnewstoday.com
Atherosclerosis is a condition in which a person’s arteries become blocked or narrowed due to the buildup of fatty deposits called plaques. The buildup of plaques makes it difficult for the heart to pump oxygenated blood through the subclavian artery. This can make a person more at risk of subclavian steal syndrome.
How many subclavian arteries are there?from medicalnewstoday.com
A person has two subclavian arteries. Each artery sends blood to a different side of the body. The subclavian arteries send blood to the following areas:
What is SSS in neurology?from en.wikipedia.org
Neurology. Subclavian steal syndrome ( SSS ), also called subclavian steal steno-occlusive disease, is a constellation of signs and symptoms that arise from retrograde (reversed) blood flow in the vertebral artery or the internal thoracic artery, due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery.
How many people have subclavian steal?from medicalnewstoday.com
According to a 2019 report, experts estimate that subclavian steal syndrome affects between 0.6% and 6.4% of the general population.
Why is subclavian steal not a cause of lifestyle changes?
This is because in most cases, the cause is atherosclerosis.
What are the risk factors for subclavian steal?
Other possible risk factors for subclavian steal syndrome include: large artery vasculitis, which is the medical term for inflammation of the large arteries. thoracic outlet syndrome, which is a group of conditions that occur when the blood vessels or nerves between the collarbone and first rib become compressed.
What is the cause of subclavian steal?
Subclavian steal syndrome occurs when the heart has difficulty pumping oxygenated blood through the subclavian artery. This can cause some degree of retrograde blood flow within the subclavian artery and the arteries that branch off from it.
Why is my subclavian artery narrowing?
Atherosclerosis is a condition in which a person’s arteries become blocked or narrowed due to the buildup of fatty deposits called plaques. The buildup of plaques makes it difficult for the heart to pump oxygenated blood through the subclavian artery. This can make a person more at risk of subclavian steal syndrome.
How many people have subclavian steal?
According to a 2019 report, experts estimate that subclavian steal syndrome affects between 0.6% and 6.4% of the general population.
Can a duplex ultrasound confirm subclavian steal?
Sometimes, however, duplex ultrasounds are not precise enough to give a doctor all the information they need to confirm a diagnosis of subclavian steal syndrome. In such cases, the doctor may recommend a magnetic resonance angiography (MRA). An MRA uses an MRI scanner to visualize blood flow in a person’s body.
Can subclavian steal syndrome be a symptom?
People with subclavian steal syndrome often do not experience any symptoms. If symptoms do develop, they will vary according to the arteries it affects.
How does subclavian steal syndrome work?
Subclavian steal syndrome works like this: atherosclerosis produces a blockage (either partial or complete) in one of the subclavian arteries just prior to the take-off of the vertebral artery. Blood flow to both the affected subclavian artery (which supplies the arm) and the vertebral artery are thus diminished.
What are the risk factors for subclavian steal syndrome?
Subclavian steal syndrome is most commonly a manifestation of PAD, so its risk factors are the ones we all know about for cardiovascular disease: hypertension, diabetes, smoking, elevated cholesterol levels, sedentary lifestyle, and being overweight.
What is the name of the disease that causes blood to be shunted away from the brain to the affected arm?
Subclavian steal syndrome , a form of peripheral artery disease (PAD), is a set of symptoms caused by a blockage in one of the subclavian arteries, the large arteries that supply the arms. Because of the location of the blockage, blood is shunted (“stolen”) away from the brain to the affected arm. 1 Consequently, the symptoms of subclavian steal syndrome include not only arm symptoms but also neurological symptoms.
What are the symptoms of a blockage in the arm?
These neurological symptoms may include lightheadedness , syncope (loss of consciousness), double vision and other visual disturbances, ringing in the ears, and vertigo . As the degree of blockage increases, symptoms occur with less and less arm exercise.
Why does blood get shunted away from the brain?
Because of the location of the blockage, blood is shunted (“stolen”) away from the brain to the affected arm. Consequently, the symptoms of subclavian steal syndrome include not only arm symptoms but also neurological symptoms. Frank van Delft / Cultura / Getty Images.
Does the brain wane when you have a reversal of blood flow?
This reversal in blood flow in the vertebral artery can wax and wane, depending on how actively the affected arm is being used. 5 As a result, not only does the affected arm have the potential for a diminished blood supply, but so does the brain.
Can you have subclavian steal at rest?
The symptoms of subclavian steal syndrome depend on the degree of blockage in the subclavian artery, and on the amount of work being performed by the affected arm. Often when subclavian steal is present,there may be no symptoms at all at rest. But, if the blockage is large enough, two things can happen when the affected arm is exercised.
What is the US for subclavian steal?
US is the preferred imaging modality for showing subclavian steal syndrome, caused by stenosis or occlusion of the subclavian artery proximal to the origin of the vertebral artery. To maintain adequate perfusion, the distal subclavian artery and upper extremity receive blood via retrograde flow through the ipsilateral vertebral artery, bypassing the stenosis. This situation can lead to significant neurologic symptoms as blood is “stolen” through the circle of Willis from the contralateral vertebral artery. A spectrum of pulsed Doppler abnormalities can be seen, ranging from a transient decrease in mid-systolic velocity (early) to complete flow reversal (late) in the ipsilateral vertebral artery.
What is the occlusive disease of the subclavian artery?
Occlusive disease in the subclavian arteries or the innominate artery can give rise to extracranial steal syndromes. The most defined syndrome is the subclavian steal syndrome . In this condition, occlusive disease in the proximal subclavian artery can lead to a siphoning of blood away from the brain by a reversal of flow down the vertebral artery on the affected side to the ischemic limb. The pulse and blood pressure are diminished in the affected limb. The symptoms may include headache, vertebrobasilar ischemia, and limb claudication, often precipitated by exercise. A bruit may be heard over the subclavian artery. The limb may become cyanotic if it is held above the level of the heart. It should be noted that a majority of people with subclavian steal detected by noninvasive techniques have no neurological symptoms.25
What is SSS in a patient?
Subclavian steal syndrome (SSS) is a condition secondary to an occlusion in the proximal subclavian artery which leads to upper-extremity blood supply to be derived by reversal of flow within the ipsilateral VA. Symptoms of SSS include vertigo during arm exertion and hand or arm pain, and numbness or weakness in the arm involved due to hypoperfusion. Also, patients exhibit marked differences in blood pressure between the left and right arms (typically > 20 mmHg). Retrograde flow in the VA is the classic hallmark of this syndrome, which can be divided into four types on the basis of characteristic waveform changes. Each waveform is defined by the ratio of the flow velocity at the mid-systolic notch to the flow velocity at the end diastole. The greater the ratio, the more advanced is the steal phenomenon ( Kliewer et al., 2000 ). Type I steal is characterized by a mild notch between systolic peaks, type II steal demonstrates a more pronounced systolic notch, while a type III steal shows a systolic notch extending to or slightly below baseline. In the most severe steal (type IV), flow in the ipsilateral VA is completely retrograde.
What is SSS in medical terms?
Subclavian steal syndrome (SSS): This term refers to the clinical syndrome that results after the development of flow reversal in the ipsilateral vertebral artery with a hemodynamically significant subclavian artery stenosis or occlusion. Subclavian steal syndrome implies the presence of symptoms due to arterial insufficiency in the brain, specifically, posterior circulation symptoms. The diagnosis of SSS requires the presence of neurologic symptoms usually triggered by arm exercise with all of the following: (1) evidence of subclavian or innominate artery occlusion or marked stenosis, (2) retrograde vertebral flow, and (3) patency of both vertebral and the basilar arteries.
What is the name of the disease that occurs when blood is shunted away from the brain?
Subclavian steal syndrome describes vertebrobasilar symptoms (dizziness, syncope, and stroke) that occur when blood is shunted away from the brain via retrograde flow in the ipsilateral vertebral artery due to stenosis/occlusion of the subclavian artery proximal to the vertebral artery.
What is the steal syndrome?
Coronary-subclavian steal syndrome: Coronary-subclavian steal phenomenon is seen in patients with prior coronary artery bypass surgery (CABG) using the internal mammary artery (IMA). In the presence of a hemodynamically significant subclavian stenosis proximal to the origin of the IMA, flow through the IMA may reverse and “steal” flow from the coronary vasculature during upper extremity exercise. Coronary and graft angiography can demonstrate retrograde flow in the involved IMA during selective angiography of the grafted coronary artery. Simultaneous coronary and cerebrovascular ischemia have also been reported. Identification of significant subclavian artery stenosis prior to CABG can prevent this important problem. Those patients with a high-grade subclavian artery stenosis should be treated prior to placement of an internal mammary graft. Grafting the IMA to the left anterior descending (LAD) coronary artery during CABG operations has been proved to have the highest patency rate and is associated with the highest survival and lower complications when compared to other conduits. 45 Therefore, any interruption in the hemodynamic integrity of this conduit, which includes S/IA stenosis, may jeopardize the clinical benefit and result in coronary-subclavian steal syndrome.
Is a subclavian steal a cause of ischemia?
Contrary to earlier beliefs that most patients with SSS have symptoms, the subclavian steal alone is rarely a cause of posterior circulation ischemia. 214 The advancement of noninvasive imaging tools has contributed to better understanding of the natural history of a subclavian steal. Bornstein and Norris 215 reported a 2-year follow-up review of 32 patients with asymptomatic subclavian steal with no cerebrovascular event related to the steal. Moran and associates 216 studied 55 patients with SSS with Doppler ultrasonography over a mean follow-up period of 4.1 years, during which only 7.2% of patients experienced symptoms of vertebrobasilar ischemia. No posterior circulation strokes were reported. However, 18% of the patients had symptoms of anterior circulation ischemia or stroke. Hennerici and colleagues 217 reviewed the medical records of 324 patients in whom subclavian steal was detected on the basis of Doppler ultrasonography and reported symptoms of vertebrobasilar ischemia in only 5% of these patients. 217 The majority of patients (64%) were asymptomatic. The remainder had lateralizing hemispheric symptoms. These studies suggested that SSS might become symptomatic when there is hemodynamic insufficiency in the presence of coexisting severe carotid occlusive disease or inadequate intracranial collateralization. For these reasons, revascularization is not advocated for asymptomatic patients.
Abstract
To determine the risk of stroke in patients with subclavian steal syndrome (SSS). We identified 165 patients with imaging-proven SSS from two hospitals. Demographic, clinical and imaging data were retrospectively collected. Patients were followed up for stroke events. Stroke occurred in 43 patients with a median follow-up of 28 months.
1. Introduction
Subclavian steal syndrome (SSS), also called subclavian steal phenomenon, is a constellation of signs and symptoms that arises from retrograde flow of blood in the vertebral artery or the internal thoracic artery, due to a proximal stenosis or occlusion of the subclavian artery [1], [2].
2. Conclusion
In conclusion, only presence of symptoms on presentation was a significant risk factor for stroke in patients with imaging-proven SSS.
Funding
This work was supported by the Natural Science Foundation of China (81301988 to L.Y.), China Ministry of Education Doctoral Program Spot Foundation (20130162120061to L.Y.), and Shenghua Yuying Project of Central South University to L.Y.
What is subclavian steal syndrome?
A subclavian steal syndrome may occur when a significant stenosis in the subclavian artery compromises distal perfusion to the IMA, vertebral artery, or axillary artery. As the degree of subclavian stenosis progresses, the pressure distal to the stenosis will eventually fall below the pressure transmitted by the contralateral (noncompromised) vertebral artery via the basilar artery or by the carotid artery through the Circle of Willis and basilar artery ( Figure 2 ). The result is a pressure gradient favoring reversed blood flow (retrograde flow) in the vertebral artery distal and ipsilateral to the subclavian stenosis. 1
What is the most common complaint of subclavian stenosis?
In the minority of patients who manifest symptoms related to subclavian stenosis, arm claudication is the most common complaint, consisting of exercise-induced arm pain or fatigue. Occasionally, coolness or paresthesias in the extremity may be noted at rest or with exertion.
What imaging is used to diagnose subclavian stenosis?
A variety of noninvasive imaging modalities can be selectively used to diagnose subclavian stenosis when a steal phenomenon is suspected. Continuous wave Doppler and duplex ultrasonography are readily accessible, inexpensive, and accurate when performed by an experienced operator. 12 Transcranial Doppler may be more useful in the setting of neurological symptoms. Magnetic resonance angiography and computed tomography angiography are also alternatives, but are perhaps best used to quantify the degree of subclavian artery stenosis when Doppler techniques are inconclusive, if the etiology of subclavian stenosis is uncertain, or for planning interventions. Magnetic resonance angiography offers comparable resolution to computed tomography angiography, but, for reasons of cost and availability, is used most commonly when computed tomography angiography is contraindicated or indeterminate.
What is the steal phenomenon 4?
Finally, a coronary-subclavian steal phenomenon 4 may occur in patients who have undergone coronary artery bypass graft if a stenosis occurs in the subclavian artery proximal to the takeoff of an IMA graft utilized to perfuse the heart.
What causes a subclavian stenosis?
Atherosclerosis is the most common cause of subclavian stenosis and, thus, steal syndromes, irrespective of the clinical manifestation. 2, 5, 6 However, large artery vasculitis, thoracic outlet syndrome, and stenosis after surgical repair of aortic coarctation or tetralogy of Fallot (with a Blalock-Taussig shunt) are other possible causes. Congenital abnormalities, such as a right-sided aortic arch with an isolated left subclavian artery, can also lead to subclavian narrowing and steal syndromes and should be considered, particularly if a steal syndrome develops in a younger patient.
How old was the woman who had a heart bypass?
A 90-year-old woman who underwent coronary artery bypass graft surgery 15 years ago was brought to the Emergency Department from her assisted living facility after developing chest pain, dyspnea, and diaphoresis. On arrival, she continued to have chest pain and exhibited signs of congestive heart failure.
Does incidental subclavian stenosis require revascularization?
Incidental subclavian stenosis, in the absence of symptoms, rarely requires revascularization therapy , even if flow reversal is demonstrated. The lone exception is among patients in whom coronary artery bypass graft with an ipsilateral IMA graft is planned. Here, pre-emptive treatment of the subclavian stenosis is recommended. 8
