Subclavian Steal Syndrome: An Underrecognized Manifestation of Atherosclerosis - Review of the Current Literature with a Case Report

Abstract

Subclavian steal is a term used to describe hemodynamics of blood flow in the branches of subclavian artery in patients with an occlusive or stenotic lesion in the proximal subclavian artery. This leads to a retrograde or reversed flow in the ipsilateral vertebral artery supplied by the contralateral vascular bed due to minimal anterograde pressure in the ipsilateral branch. The occlusive lesion is most commonly due to significant atherosclerotic disease. Most patients remain asymptomatic despite having an occlusive lesion. Subclavian steal syndrome (SSS) is the term used when patients develop symptoms related to poor blood supply in the regions supplied by the vertebral artery (posterior circulation symptoms like transient ischemic attacks, vertigo, and dizziness) and/or the brachial artery (arm claudication). Diagnosis is usually made using Doppler ultrasonography (USG), but other cross-sectional imaging modalities have shown increased prevalence than once thought. Most patients are managed conservatively; however symptomatic patients may need additional endovascular or surgical intervention. Herein, we present a patient of SSS who received subclavian artery stenting followed by complete resolution of symptoms and also review the clinical and management aspects of SSS in detail.