Abstract
Background："Stealing" of the subclavian artery is a phenomenon where proximal subclavian artery stenosis or occlusion causes retrograde blood flow in the ipsilateral vertebral artery. This, combined with ischemic symptoms of vertebrobasilar arteries or ipsilateral upper limb artery, is called subclavian steal syndrome. Sometimes, subclavian steal syndrome can occur in patients without subclavian artery stenosis, such as in patients with high-flow arteriovenous dialysis fistulas or subclavian artery aneurysms. Interestingly, compared with classic atherosclerotic subclavian steal syndrome, the former patient is more prone to symptoms like paroxysmal vertigo, drop attacks, diplopia, and arm claudication. Case Presentation ： In our case, we present a 35-year-old male who suffered from paroxysmal vertigo. Clinical physical examination did not reveal any substantial evidence of proximal subclavian artery stenosis. Transcranial Doppler and ultrasonography revealed an abnormal blood flow pattern in the right vertebral artery, consistent with partial subclavian steal syndrome. Ultrasonography and computed tomography angiography showed no stenosis in the right subclavian artery and three aneurysms in the proximal segment. The hypoplastic vertebral artery originated from the third aneurysm. Conclusions ： There are few reports of subclavian steal syndrome caused by subclavian aneurysms in the literature; our case is the first to report partial subclavian steal syndrome caused by multiple aneurysms. Following a literature review, combined with our analysis of this case, we suggest that subclavian artery aneurysm which induced subclavian steal syndrome is an often unnoticed cause of vertigo.
A large subclavian artery aneurysm inducing subclavian steal syndrome
