Initial Experience with Routine Selective Carotid Arteriography by Vascular Surgeons

2006 ◽  
Vol 72 (8) ◽  
pp. 684-687 ◽  
Author(s):  
Joe H. Morgan ◽  
Joe H. Johnson ◽  
Randall B. Brown ◽  
Richard L. Harvey ◽  
Walter E. Rizzoni ◽  
...  
Keyword(s):  
Carotid Arteries ◽  
Guide Wire ◽  
Carotid Bifurcation ◽  
Subclavian Steal Syndrome ◽  
Vertebrobasilar Insufficiency ◽  
Carotid Angiography ◽  
Contrast Administration ◽  
Proximal Occlusion ◽  
Common Carotid Arteries ◽  
Steal Syndrome

We report the results of our first 2 years of experience with routine carotid angiography with an emphasis on technique and complications. We reviewed the hospital records, office charts, and prospective quality-assurance database records of 336 patients undergoing cerebrovascular arteriograms and collected data on the indications, complications, and technical aspects of the procedures. Indications for angiography included carotid stenosis in 331 (95%) patients, subclavian steal syndrome in 9 patients, vertebrobasilar insufficiency in 6 patients, and carotid body tumor in 2 patients. Selective catheterizations were performed on 654 common carotid arteries, 63 subclavian arteries, and 63 vertebral arteries. Both common carotid arteries were not selectively catheterized in 34 (9.8%) patients. Reasons for not selecting one or both common carotid arteries included physician choice to limit contrast administration in patients with renal insufficiency in 16 cases, proximal occlusion in 4 cases, proximal stenosis thought to be at risk of embolization if instrumented in 3 cases, imaging equipment malfunction in 2 cases, and in only 9 (2.6%) cases was selective carotid catheterization attempted but unsuccessful. There were no procedure-related deaths. Complications were documented in six (1.8%) patients, including cerebrovascular accident (CVA) in 1 (0.3%) patient. One hundred forty-two (41%) patients went on to carotid endarterectomy, and we performed 16 carotid bifurcation stents during the study period. Routine selective carotid angiography is a low-risk procedure that can be performed safely by vascular surgeons with catheter/guide wire skills.

scholarly journals Subclavian Steal Syndrome Secondary to Atherosclerosis: A Case Report and Review of Literature

2021 ◽  
Author(s):  
Sunil Basukala ◽  
Bishnu Pathak ◽  
Sabina Rijal ◽  
Bibek Karki ◽  
Narayan Thapa
Keyword(s):  
Case Report ◽  
Innominate Artery ◽  
Limb Ischemia ◽  
Subclavian Steal Syndrome ◽  
Vertebrobasilar Insufficiency ◽  
Review Of Literature ◽  
Common Cause ◽  
Subclavian Steal ◽  
Proximal Occlusion ◽  
Steal Syndrome

Subclavian Steal Syndrome (SSS) is a rare vascular syndrome caused due to proximal occlusion or stenosis of subclavian or innominate artery. It is usually asymptomatic but occasionally may present with vertebrobasilar insufficiency and/or upper limb ischemia. Atherosclerosis is the most common cause.

Duplex ultrasound in the subclavian steal syndrome

1998 ◽  
Vol 39 (2) ◽  
pp. 183-188 ◽  
Author(s):  
M. Pãivänsalo ◽  
O. Heikkilä ◽  
T. Tikkakoski ◽  
S. Leinonen ◽  
J. Merikanto ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Carotid Arteries ◽  
Subclavian Steal Syndrome ◽  
Retrograde Flow ◽  
Subclavian Steal ◽  
The Us ◽  
The Common ◽  
Common Carotid Arteries ◽  
Steal Syndrome ◽  
Carotid Flow

Purpose: the effect of subclavian steal on the contralateral vertebral flow and its possible effect on carotid flow were studied and the US results were compared to the angiographic findings Material and Methods: the study consisted of the records of 74 patients with a duplex Doppler finding of subclavian steal syndrome. of these, 48 patients had had both angiography and US of the neck arteries and were selected for comparison. for a comparison of the US flow values, a control series of 48 was selected from our carotid archive and consisted of patients without subclavian steal who had also been examined with both US and angiography Results: of the 48 patients, 44 had a subclavian steal syndrome at angiography, 31 on the left side and 13 on the right. of the 44, 21 patients had subclavian occlusion, and 23 stenosis. in 84% of the subclavian occlusions, US showed a complete systodiastolic steal and in 16% a partial systolic steal, while the corresponding findings for subclavian stenoses were 17% and 83%. of the 48 cases, 4 were not real subclavian steals: 2 had vertebral occlusion (1 with a 90% subclavian diameter stenosis) on the side of retrograde flow at US and a steal through the vertebral and collateral arteries to the spinal arteries; and 2 had a 70% diameter stenosis of the subclavian artery and to-and-fro flow in the vertebral artery at angiography. in the 21 cases of complete steals, the subclavian diameter stenosis was 97±8% at angiography, and in the 23 partial steals, it was 85±10%. There was a significant increase in contralateral vertebral and common carotid flow in the cases with retrograde vertebral flow compared to the vertebral and common carotid flow of the control subjects. the retrograde flow values, the ipsilateral vertebral lumen diameter, and the flow values in the common carotid arteries were higher in complete steals and subclavian occlusions than in partial steals Conclusion: A complete vertebral steal at US correlated well with subclavian occlusion and a partial steal suggested stenosis of the subclavian artery. There were also flow changes in the contralateral vertebral artery and the common carotid arteries that compensated for the steal. Retrograde vertebral flow at US was sometimes associated with vertebral occlusion in subclavian stenosis without a true subclavian steal

scholarly journals Synchronous Carotid Bifurcation Endarterectomy and Retrograde Kissing Stenting of the Innominate and Left Common Carotid Artery in a Patient with a Bovine Aortic Arch

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Alessandro Robaldo ◽  
Guido Carignano ◽  
Alberto Balderi ◽  
Claudio Novali
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
High Risk Patient ◽  
Carotid Bifurcation ◽  
Left Common Carotid Artery ◽  
The Right ◽  
Bovine Aortic Arch ◽  
Common Carotid Arteries

Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a “bovine” aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters.

scholarly journals Ruptured vertebrobasilar junction aneurysm unmasking subclavian steal syndrome

2020 ◽  
Vol 11 ◽  
pp. 419
Author(s):  
Vivek Murumkar ◽  
Shumyla Jabeen ◽  
Sameer Peer ◽  
Aravinda Hanumanthapura Ramalingaiah ◽  
Jitender Saini
Keyword(s):  
Vertebral Artery ◽  
Subclavian Artery ◽  
Subclavian Steal Syndrome ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Subclavian Steal ◽  
Subclavian Artery Occlusion ◽  
Retrograde Filling ◽  
Vertebrobasilar Junction ◽  
Steal Syndrome

Background: Subclavian steal occurs due to stenosis or occlusion of the subclavian artery or innominate artery proximal to the origin of the vertebral artery. Often asymptomatic, the condition may be unmasked due to symptoms of vertebrobasilar insufficiency triggered by strenuous physical exercise involving the affected upper limb. The association of vertebrobasilar junction (VBJ) aneurysms with subclavian steal syndrome has been rarely reported. Hereby, we present a case of VBJ aneurysm associated with subclavian steal treated successfully with endovascular coiling. Case Description: A 65-year-old female presented in the emergency department with acute severe headache and vomiting with no focal neurological deficits. Non-contrast computed tomography of the brain showed modified Fischer Grade 3 subarachnoid hemorrhage. Subsequent digital subtraction angiogram (DSA) showed VBJ aneurysm directed inferiorly with the left subclavian artery occlusion. There was retrograde filling of the left vertebral artery on right vertebral injection, confirming the diagnosis of subclavian steal. Balloon assisted coiling of the VBJ aneurysm was performed while gaining access through the stenotic left vertebral artery ostium which provided a more favorable hemodynamic stability to the coil mass. Conclusion: Subclavian steal exerting undue hemodynamic stress on vertebrobasilar circulation can be an etiological factor for the development of the flow-related aneurysms. Access to the VBJ aneurysms may be feasible through the stenosed vertebral artery if angioplasty is performed before the coiling of the aneurysm.

scholarly journals Treatment of subclavian steal syndrome with percutaneous transluminal angioplasty and stenting: case report

2003 ◽  
Vol 61 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Felipe Fregni ◽  
Luiz Eduardo Coutinho Castelo-Branco ◽  
Adriana Bastos Conforto ◽  
Fabio Iuji Yamamoto ◽  
Cynthia Resende Campos ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Left Subclavian Artery ◽  
Therapeutic Option ◽  
Transluminal Angioplasty ◽  
Subclavian Steal Syndrome ◽  
Vertebrobasilar Insufficiency ◽  
Subclavian Steal ◽  
Angioplasty And Stenting ◽  
Percutaneous Transluminal ◽  
Steal Syndrome

Subclavian steal syndrome refers to the association of neurological symptoms related to vertebrobasilar insufficiency and the phenomenon of subclavian steal. We report the case of a 63 year-old male patient that presented subclavian steal syndrome and severe proximal (80%) stenosis of the left subclavian artery. The patient was submitted to percutaneous transluminal angioplasty and stenting on the left SA. The procedure was well tolerated and immediately afterwards, there was complete remission of the symptoms and of the phenomenon of subclavian steal evaluated by angiography and transcranial doppler. We propose that percutaneous transluminal angioplasty with stenting placement is a good therapeutic option for subclavian steal syndrome.

scholarly journals Endovascular Treatment in the Subclavian Steal Syndrome

2019 ◽  
Vol 38 (02) ◽  
pp. 137-140
Author(s):  
Luana Antunes Maranha Gatto ◽  
Jennyfer Paulla Galdino Chaves ◽  
Cássio Henrique Mendes ◽  
Diego do Monte Rodrigues Seabra ◽  
Gelson Luis Koppe ◽  
...  
Keyword(s):  
Treatment Options ◽  
Diagnostic Methods ◽  
Subclavian Steal Syndrome ◽  
Subclavian Steal ◽  
Reversal Flow ◽  
Clinically Significant ◽  
Supply Reduction ◽  
Proximal Occlusion ◽  
Steal Syndrome ◽  
Multiple Episodes

AbstractWhen the proximal occlusion or stenosis of the subclavian or of the brachiocephalic artery may require distal arterial filling through reversal flow from the vertebral artery, causing clinically significant blood supply reduction to the brainstem, it is called subclavian steal syndrome (SSS). We report a 54-year-old male patient who presented with multiple episodes of syncopes and vascular claudication due to right SSS. He underwent an angioplasty, evolving with complete improvement of the symptoms. We review the clinical presentation, the diagnostic methods, and the treatment options of the disease.

scholarly journals I Left Vertebral Artery with a Proximal Stenotic Origin and Clinical Implications

2021 ◽  
Vol 4 (4) ◽  
pp. 01-03
Author(s):  
Olutayo Ariyo
Keyword(s):  
Vertebral Artery ◽  
Subclavian Artery ◽  
Deleterious Effect ◽  
Vital Role ◽  
Subclavian Steal Syndrome ◽  
Left Vertebral Artery ◽  
Anatomical Structures ◽  
Left Limb ◽  
Proximal Occlusion ◽  
Steal Syndrome

Even though most vertebral artery anomalies are asymptomatic, but the normally arising vertebral artery from the superoposterior surface of its ipsilateral subclavian artery, plays a vital role, via the Subclavian Steal Syndrome to help in vascularization of its ipsilateral upper limb anatomical structures. The case of a left vertebral artery with a proximal origin stenosis in the left limb of a 72 year -old female cadaver is reported and its pathophysiological consequences of the stenosis in an hypothesized proximal occlusion in ipsilateral subclavian artery considered. The left vertebral artery originated normally from the superior -posterior surface of the left subclavian artery, but with a proximal stenotic origin in its proximal 1-1/2mm length. The LVA was of a good caliber size distal to the stenotic segment, proceeding in its pre-foraminal segment superiorly, entering normally the 6th transverse cervical foraminal to begin its osseous path. Proximal stenosis of the vertebral artery are uncommon, but this tends to have a deleterious effect on the posterior circulation in the brain depending on the severity of such stenosis. Stenosis although most frequent in the artery’s 1st part tends to have more deleterious effect with Knowledge of vertebral artery pathologies, its variant origins, lumen size, are important to Head and Neck, Neurosurgeons, Interventional Neuroradiologists in the choice of appropriate surgical and medical managements and to neuroradiologists in the interpretation of images.

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