Abstract
Double steal syndrome is a phenomenon that has been minimally described in the literature and here we present two cases. The first case presented with symptoms and early evidence of reversal of flow on carotid duplex in the right proximal internal carotid artery with significant innominate stenosis. The second case was an asymptomatic patient with clear retrograde flow observed in the right proximal internal carotid artery with innominate stenosis. Both patients were also found to have reversal of flow in the vertebral artery of the ipsilateral side. Intervention consisted of stent placement at the proximal origin of the innominate artery. Both patients remained on clopidogrel according to post-procedure instructionsand returned to the clinic within the first week for follow up carotid duplex demonstrating decreased innominate velocity with antegrade right internal carotid and vertebral artery flow.
Highlights
Atherosclerotic disease of the branches from the aortic arch may cause high grade stenosis or may occlude the arch branch vessels
Stenosis of the innominateartery will decrease the inflow to the right upper extremity as well as to the right carotid which has potential to result in ipsilateral upper extremity
We have presented two cases of innominate stenosis with consequent ipsilateral vertebral artery retrograde flow known as double steal syndrome as documented in the literature
Summary
Atherosclerotic disease of the branches from the aortic arch may cause high grade stenosis or may occlude the arch branch vessels. A 6 mm×18 mm bare metal balloon expandable stent was deployed across the origin of the Figure 3b: (Case 1) Post-procedure carotid duplex demonstrating antegrade flow in the right vertebral artery. She had a history of transient ischemic attacks with the most recent 2 months prior to presentation She received a carotid duplex at an outside facility demonstrating loss of normal waveforms in the right common carotid artery (CCA) with reversal of flow at the end of diastole and significant stenosis. Figure 4a: (Case 2) Pre-procedure carotid duplex demonstrating complete reversal of flow in proximal right ICA. Figure 4b: (Case 2) Pre-procedure carotid duplex demonstrating retrograde flow in the right vertebral artery. A repeat carotid duplex was scheduled 3 months post procedure
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