CRCM  Vol.3 No.2 , February 2014
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.

Cite this paper
Dragičević, D. , Škorić, M. , Kolić, K. and Titlić, M. (2014) A case of acquired right-sided subclavian steal syndrome successfully treated with stenting using brachial approach. Case Reports in Clinical Medicine, 3, 70-75. doi: 10.4236/crcm.2014.32017.
[1]   Miller Fischer, C. (1961) A new vascular syndrome “The subclavian steal”. New England Journal of Medicine, 265, 912-913.

[2]   Taylor, C.L., Selman, W.R. and Ratcheson, R.A. (2002) Steal affecting the central nervous system. Neurosurgery, 50, 679-688.

[3]   Hennerici, M., Klemm, C. and Rautenberg, W. (1988) The subclavian steal phenomenon: A common vascular disorder with rare neurologic deficits. Neurology, 38, 669-673.

[4]   Osiro, S., Zurada, A., Gielecki, J., Shoja, M.M., Tubbs, R.S. and Loukas, M. (2012) A review of subclavian steal syndrome with clinical correlation. Medical Science Monitor, 18, 57-63.

[5]   Edwards Jr., W.H., Tapper, S.S., Edwards Sr., W.H., Mulherin Jr., J.L., Martin 3rd, R.S. and Jenkins, J.M. (1994) Subclavian revascularization. A quarter century experience. Annals of Surgery, 219, 673-677.

[6]   Motarjeme, A. (1996) Percutaneous transluminal angioplasty of supra-aortic vessels. Journal of Endovascular Surgery, 3, 171-181.<0171:PTASAV>2.0.CO;2

[7]   Motarjeme, A. and Gordon, G.I. (1993) Percutaneous transluminal angioplasty of the brachiocephalic vessels: Guidelines for therapy. International Angiology, 12, 260-269.

[8]   Carlson, R.E., Ehrenfeld, W.K., Stoney, R.J. and Wylie, E.J. (1977) Innominate artery endarterectomy. A 16-year experience. Archives of Surgery, 112, 1389-1393.

[9]   Kieffer, E., Sabatier, J., Koskas, F. and Bahnini, A. (1995) Atherosclerotic innominate artery occlusive disease: Early and long-term results of surgical reconstructions. Journal of Vascular Surgery, 2, 326-336.

[10]   Berguer, R., Monasch, M.D. and Kline, R.A. (1998) Transthoracic repair of innominate and common carotid artery disease: Immediate and long term outcome for 100 consecutive surgical reconstructions. Journal of Vascular Surgery, 27, 34-41.

[11]   Schillinger, M., Haumer, M., Schillinger, S., Ahmadi, R. and Minar, E. (2001) Risk stratification for subclavian artery angioplasty: Is there an increased rate of restenosis after stent implantation? Journal of Endovascular Therapy, 8, 550-557.<0550:RSFSAA>2.0.CO;2

[12]   Bates, M.C., Broce, M., Lavigne, P.S. and Stone, P. (2004) Subclavian artery stenting: Factors influencing long-term outcome. Catheterization and Cardiovascular Interventions, 61, 5-11.

[13]   Alcocer, F., David, M., Goodman, R., Jain, S.K. and David, S. (2013) A forgotten vascular disease with important clinical implications. Subclavian steal syndrome. American Journal of Case Reports, 14, 58-62.

[14]   Labropoulos, N., Nandivada, P. and Bekelis, K. (2010) Prevalence and impact of the subclavian steal syndrome. Annals of Surgery, 252, 166-170.

[15]   Schillinger, M., Haumer, M., Schillinger, S., Mlekusch, W., Ahmadi, R. and Minar, E. (2002) Outcome of conservative versus interventional treatment of subclavian artery stenosis. Journal of Endovascular Therapy, 9, 139-146.<0139:OOCVIT>2.0.CO;2

[16]   Staikov, I.N., Do, D.D., Remonda, L., Mattle, H., Baumgartner, R. and Schroth, G. (1999) The site of atheromatosis in the subclavian and vertebral arteries and its implication for angioplasty. Neuroradiology, 41, 537-542.

[17]   Nicholls, S.C., Koutlas, T.C. and Strandness, D.E. (1991) Clinical significance of retrograde flow in the vertebral artery. Annals of Vascular Surgery, 5, 331-336.

[18]   De Vries, J.P., Jager, L.C., Van den Berg, J.C., Overtoom, T.T., Ackerstaff, R.G., Van de Pavoordt, E.D. and Moll, F.L. (2005) Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: Long-term results. Journal of Vascular Surgery, 41, 19-23.

[19]   Tan, T.Y., Schminke, U., Lien, L.M. and Tegeler, C.H. (2002) Subclavian steal syndrome: Can the blood pressure difference between arms predict the severity of steal? Journal of Neuroimaging, 12, 131-135.

[20]   Bornstein, N.M. and Norris, J.W. (1986) Subclavian steal: A harmless hemodynamic phenomenon? Lancet, 2, 303-305.

[21]   Smith, J.M., Koury, H.I., Hafner, C.D. and Welling, R.E. (1994) Subclavian steal syndrome. A review of 59 consecutive cases. Journal of Cardiovascular Surgery (Torino), 35, 11-14.

[22]   Guan, H., Liu, C.W. and Xiao, Y. (1994) Subclavian steal syndrome: A report of 25 cases. Chinese Medical Journal, 32, 154-156.

[23]   Motarjeme, A., Keifer, J.W., Zuska, A.J. and Nabawi, P. (1985) Percutaneous transluminal angioplasty for treatment of subclavian steal. Radiology, 155, 611-613.

[24]   Wilms, G., Baert, A., Dewaele, D., Vermylen, J., Nevelsteen, A. and Suy, R. (1987) Percutaneous transluminal angioplasty of the subclavian artery: Early and late results. Cardiovascular Interventional Radiology, 10, 123-128.

[25]   Sullivan, T.M., Gray, B.H., Bacharach, J.M., Perl 2nd, J., Childs, M.B., Modzelewski, L. and Beven, E.G. (1998) Angioplasty and primary stenting of the subclavian, innominate, and common carotid arteries in 83 patients. Journal of Vascular Surgery, 28, 1059-1065.

[26]   Henry, M., Amor, M., Henry, I., Ethevenot, G., Tzvetanov, K. and Chati, Z. (1999) Percutaneous transluminal angioplasty of the subclavian arteries. Journal of Endovascular Surgery, 6, 33-41.<0033:PTAOTS>2.0.CO;2

[27]   Westerband, A., Rodriguez, J.A., Ramaiah, V.G. and Diethrich, E.B. (2003) Endovascular therapy in prevention and management of coronary-subclavian steal. Journal of Vascular Surgery, 38, 699-703.

[28]   Martinez, R., Rodriguez-Lopez, J., Torruella, L., Ray, L., Lopez-Galarza, L. and Diethrich, E.B. (1997) Stenting for occlusion of the subclavian arteries. Technical aspects and follow-up results. Texas Heart Institute Journal, 24, 23-27.

[29]   Al-Mubarak, N., Liu, M.W., Dean, L.S., Al-Shaibi, K., Chastain 2nd, H.D., Lyer, S.S. and Roubin, G.S. (1999) Immediate and late outcomes of subclavian artery stenting. Catheterization and Cardiovascular Interventions, 46, 169-172.<169::AID-CCD11>3.0.CO;2-4

[30]   Rodriguez-Lopez, J.A., Werner, A., Martinez, R., Torruella, L.J., Ray, L.I. and Diethrich, E.B. (1999) Stenting for atherosclerotic occlusive disease of the subclavian artery. Annals of Vascular Surgery, 13, 254-260.

[31]   Diethrich, E.B., Garrett, H.E., Ameriso, J., Crawford, E.S., El-Bayar, M. and De Bakey, M.E. (1967) Occlusive disease of the common carotid and subclavian arteries treated by carotid-subclavian bypass. The American Journal of Surgery, 114, 800-808.

[32]   Parrott, J.C. (1964) The subclavian steal syndrome. JAMA, 88, 661-665.

[33]   Vitti, M.J., Thompson, B.W., Read, R.C., Gagne, P.J., Barone, G.W., Barnes, R.W. and Eidt, J.F. (1994) Carotidsubclavian bypass: A twenty-two-year experience. Journal of Vascular Surgery, 20, 411-417.

[34]   Perler, B.A. and Williams, G.M. (1990) Carotid-subclavian bypass: A decade of experience. Journal of Vascular Surgery, 12, 716-722.

[35]   Kretschmer, G., Teleky, B., Marosi, L., Wagner, O., Wunderlich, M., Karnel, F., Jantsch, H., Schemper, M. and Polterauer, P. (1991) Obliterations of the proximal subclavian artery: To bypass or to anastomose? Journal of Cardiovascular Surgery (Torino), 32, 334-339.

[36]   Palchik, E., Bakken, A.M., Wolford, H.Y., Saad, W.E. and Davies, M.G. (2008) Subclavian artery revascularization: An outcome analysis based on mode of therapy and presenting symptoms. Annals of Vascular Surgery, 22, 70-78.

[37]   Motarjeme, A., Keifer, J.W. and Zuska, A.J. (1982) Percutaneous transluminal angioplasty of the brachiocephalic arteries. American Journal of Roentgenology, 138, 457-462.

[38]   Kandarpa, K., Becker, G.J., Ferguson, R.D., Connors III, J.J., Wojak, J.C. and Landow, W.J. (2001) Transcatheter interventions for the treatment of peripheral atherosclerotic lesions: Part II. Journal of Vascular and Interventional Radiology, 12, 807-812.

[39]   Erbstein, R.A, Wholey, M.H. and Smoot, S. (1988) Subclavian artery steal syndrome: Treatment by percutaneous transluminal angioplasty. American Journal of Roentgenology, 151, 291-294.

[40]   Bachman, D.M. and Kim, R.M. (1980) Transluminal dilatation for subclavian steal syndrome. American Journal of Roentgenology, 135, 995-996.

[41]   Hadjipetrou, P., Cox, S., Piemonte, T. and Eisenhauer, A. (1999) Percutaneous revascularization of atherosclerotic obstruction of aortic arch vessels. Journal of the American College of Cardiology, 33, 1238-1245.

[42]   Amor, M., Eid-Lidt, G., Chati, Z. and Wilentz, J.R. (2004) Endovascular treatment of the subclavian artery: Stent implantation with or without predilatation. Catheterization and Cardiovascular Interventions, 63, 364-370.

[43]   Mathias, K.D., Luth, I. and Haarmann, P. (1993) Percutaneous transluminal angioplasty of proximal subclavian artery occlusions. Cardiovascular and Interventional Radiology, 16, 214-218.

[44]   Sakai, C., Sakai, N., Kuroiwa, T., Ishihara, H., Adachi, H., Morizane, A., Yano, T., Kajikawa, R., Yamagami, H., Kobayashi, J., Kondo, K. and Kikuchi, H. (2007) Stenting for chronic total occlusion of the proximal subclavian artery. Interventional Neuroradiology, 13, 135-140.

[45]   Kumar, K., Dorros, G., Bates, M.C., Palmer, L., Mathiak, L. and Dufek, C. (1995) Primary stent deployment in occlusive subclavian artery disease. Catheterization and Cardiovascular Diagnosis, 34, 281-285.

[46]   Sueoka, B.L. (1996) Percutaneous transluminal stent placement to treat subclavian steal syndrome. Journal of Vascular and Interventional Radiology, 7, 351-356.

[47]   Sakaida, H., Sakai, N., Nagata, I., Sakai, H., Iihara, K., Higashi, T., Kogure, S., Takahashi, J., Ohta, H., Nagamine, T., Anei, R., Soeda, A., Taniguchi, A., Shindo, A. and Kikuchi, H. (2001) Stenting for the occlusive carotid and subclavian arteries in Takayasu arteritis. No Shinkei Geka, 29, 1033-1041.

[48]   Wang, K.Q., Wang, Z.G., Yang, B.Z., Yuan, C., Zhang, W.D., Yuan, B., Xing, T., Song, S.H., Li, T., Liao, C.J. and Zhang, Y. (2010) Long-term results of endovascular therapy for proximal subclavian artery obstructive lesions. Chinese Medical Journal, 123, 45-50.