Subclavian Artery Steal Syndrome Research Articles

Point-of-care ultrasound for stroke patients in the emergency room.

Stroke requires rapid determination of the cause to provide timely and appropriate initial management. Various ultrasonographic techniques have been evaluated as ways to determine the cause of stroke; among them, carotid artery ultrasonography is particularly useful since it provides considerable information within a short time period when used to evaluate a specific site. In the emergency room, carotid artery ultrasonography can be used to diagnose internal carotid artery stenosis, predict an occluded vessel, and infer the cause of ischemic stroke. Additionally, carotid artery ultrasonography can diagnose different conditions including subclavian artery steal syndrome, bow hunter's stroke, Takayasu's arteritis, moyamoya disease, and dural arteriovenous fistula. Furthermore, patients with ischemic stroke with a pulse deficit or hypotension must be differentiated from acute type A aortic dissection, which requires emergency surgery; carotid artery ultrasonography can immediately differentiate between the two conditions by identifying the intimal flap of the common carotid artery. The following article provides an overview of carotid artery ultrasonography performed as point-of-care ultrasound in the emergency room in patients with suspected stroke.

A Level 1 Trauma Center Experience: Is Endovascular Repair All Good for Blunt Traumatic Aortic Injury?

Introduction: Since blunt traumatic aortic injury (BTAI) carries a high mortality rate up to 10-30% [1] especially when combining with brain injury and severe thoraco-abdominal visceral organ injuries, urgent endovascular or open aortic repair (AR) for Grade (Gr) II-IV BTAI is mandatory. Endovascular aortic repair (EAR) is the first-line choice for BTAI involving descending aorta in concern of coagulopathy. [2] In case of blunt traumatic ascending aorta injury (BTAAI), EAR would be challenging. [3] This study aims at analyzing accuracy of diagnosis on computed tomography (CT), surgical strategy and results of various kinds of BTAI, including traumatic type A aortic dissection (AD) and intramural hematoma (IMH) in our Level 1 Trauma Center. Methods: From Jan. 2015 to Jan. 2019, all BTAI patients undergoing surgery are retrospectively reviewed. BTAI grading is modified with Gr IIa as IMH, Gr IIb as AD and Gr X as periaortic hemorrhage. Mechanism of injury, grade of BTAI on CT, associated injuries, injury severity score (ISS), visit-to-operation time, operative procedures, post-operative complications and re-intervention, operation-to-mortality time, cause of mortality and aortic remodeling on series of follow-up CT were recorded. Results: Total 43 patients presented 5 Gr IIa (1 type A IMH, 4 type B IMH), 11 Gr IIb (4 type A AD, 7 type B AD), 15 Gr III, 8 Gr IV and 4 Gr X BTAI. The mean ISS was 31±9. 65.1% patients got associated injuries in lungs, 44.2% in thoracic cage, 41.9% in abdomen and 39.5% in brain. Mean visit-to-operation time was 2.85 hours. Patients received hybrid AR or EAR with proximally landing at 15 Zone 2, 3 Zone 1, 2 Zone 0 and 22 beyond Zone 3. Associated operations included 10 brain, 10 abdominal, 6 orthopedic and 2 ECMO operations. There were 3 circulatory collapses before or during EAR and all of which died. 6 out of 13 mortality were found exacerbating intra-cranial and intra-abdominal hemorrhage after AR. 24-hour mortality and inhospital mortality were 20.9% and 30.2% (procedure related 38.5%, brain injury 38.5%, abdomen injury 15.4%, lung injury 7.6%). 60% patients with BTAAI underwent EAR and hybrid AR with 100% and 50% mortality respectively. Early complication rate was 7.1% with aortic valve entrapment and acute kidney injury. Re-intervention rate was 2.3% with left subclavian artery steal syndrome. Aortic healing in Gr IIa, Gr III, Gr IV and Gr X BTAI were 100%. For Gr IIb BTAI, there were 66.7% FL thrombosis beyond the aortic graft and 16.7% aortic healing. Conclusion: Diagnosis for BTAI could be mimicked by disrupted intercostal arteries, azygos vein and inferior vena cava. Exacerbations of ongoing intracranial and thoraco-abdominal hemorrhage are main causes of death if EAR is routinely applied as priority. EAR for BTAAI possessed 100% mortality in our series due to unskilled graft deployment and preoperative spinal shock. However, early EAR before aortic exsanguination and circulatory collapse has promising salvage rate and aortic remodeling in other conditions.Figure 2Associated injuries, causes of mortality and surgical outcomes of BTAI.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Disclosure: Nothing to disclose

Extracranial Carotid Duplex Ultrasonography. Part II - Clinical Utility of Carotid Duplex Ultrasound

Carotid duplex ultrasonography (CDU) is noninvasive and easy to use for evaluation of various carotid artery diseases. Carotid atherosclerosis is a major indication for CDU. CDU can determine the degree of stenosis, plaque characteristics, and intima-media thickness for evaluation and estimation of carotid atherosclerosis, and can be used as a screening and follow-up tool after carotid revascularization. Here, we summarize the clinical indications and utility of CDU based on established evidence. The main topics include: 1) Evaluation and management of symptomatic and asymptomatic carotid atherosclerotic stenosis; 2) surveillance after carotid artery revascularization; 3) screening for cardiovascular risk; 4) perioperative evaluation; 5) evaluation of other diseases including cervical artery dissection, temporal arteritis, Takayasu’s disease, and subclavian artery steal syndrome; and 6) diagnosis of dizziness, vertigo, and syncope. This special review will discuss rational indications and utility of CDU, and will be of interest to clinicians who provide care for patients with various extracranial carotid/vertebral artery diseases. Key words: Carotid duplex ultrasonography; Clinical indication; Clinical utility

Przezskórne zamknięcie zespolenia Blalocka-Taussig z dostępu ramiennego u dziecka z niedrożnością lewej tętnicy podobojczykowej i wtórnym zespołem podkradania

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Surmacz R, Moszura T, Mroziński B, et al. Case reportTranscatheter closure of Blalock-Taussig anastomosis with brachial access in a child with obstruction of the left subclavian artery and secondary subclavian steal syndrome. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2012;8(3):261-264. doi:10.5114/pwki.2012.30409. APA Surmacz, R., Moszura, T., Mroziński, B., Baszko, A., Wojtalik, M., & Bobkowski, W. et al. (2012). Case reportTranscatheter closure of Blalock-Taussig anastomosis with brachial access in a child with obstruction of the left subclavian artery and secondary subclavian steal syndrome. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 8(3), 261-264. https://doi.org/10.5114/pwki.2012.30409 Chicago Surmacz, Rafał, Tomasz Moszura, Bartłomiej Mroziński, Artur Baszko, Michał Wojtalik, Waldemar Bobkowski, and Aldona Siwińska. 2012. "Case reportTranscatheter closure of Blalock-Taussig anastomosis with brachial access in a child with obstruction of the left subclavian artery and secondary subclavian steal syndrome". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 8 (3): 261-264. doi:10.5114/pwki.2012.30409. Harvard Surmacz, R., Moszura, T., Mroziński, B., Baszko, A., Wojtalik, M., Bobkowski, W., and Siwińska, A. (2012). Case reportTranscatheter closure of Blalock-Taussig anastomosis with brachial access in a child with obstruction of the left subclavian artery and secondary subclavian steal syndrome. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 8(3), pp.261-264. https://doi.org/10.5114/pwki.2012.30409 MLA Surmacz, Rafał et al. "Case reportTranscatheter closure of Blalock-Taussig anastomosis with brachial access in a child with obstruction of the left subclavian artery and secondary subclavian steal syndrome." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 8, no. 3, 2012, pp. 261-264. doi:10.5114/pwki.2012.30409. Vancouver Surmacz R, Moszura T, Mroziński B, Baszko A, Wojtalik M, Bobkowski W et al. Case reportTranscatheter closure of Blalock-Taussig anastomosis with brachial access in a child with obstruction of the left subclavian artery and secondary subclavian steal syndrome. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2012;8(3):261-264. doi:10.5114/pwki.2012.30409.

Establishment of a novel hemodynamic cerebral ischemia model of atherosclerotic rabbit

Atherosclerosis is the most common cause of ischemic stroke. Until now, there has been no ideal animal model for studying the hemodynamic ischemia caused by atherosclerosis in posterior circulation. This study was conducted to establish a cerebral ischemic model in an atherosclerotic rabbit by subclavian artery (SA) ligation or embolization, emphasizing the role of hemodynamics. Thirty-two male New Zealand rabbits (weight, 3.5 to 4.0 kg; provided by Animal Laboratory of Tongji Hospital of Tongji University) were randomly divided into four groups. All the groups, except the controlled group, were fed with high lipid diet for three months and two of the groups were submitted for right SA ligation or left SA embolization and the remaining one group to non-operated group. A SA steal syndrome was established successfully with delayed visualization and prolonged circulation time in the posterior circulation. The circulation time was different when SA was ligated or embolized (P < 0.001), and also there was statistically significant difference between controlled and non-operated groups when angiography of either, left and right, VA was performed (P = 0.009, P = 0.003, respectively). However, there was no statistical significant difference between the ligation and embolization group either before or after the procedure (ligation or embolization) (P = 0.402, P = 0.068, respectively). In the control and non-operated group, angiography of either left or right VA showed no statistically significant difference (P = 0.285, P = 0.197, respectively). In the groups fed with high lipid diet for three months, atherosclerotic plaques were found in the common carotid arteries (CCAs), aortic arch (AAs) and variably in the internal carotid arteries (ICAs). This model could, to some extent, simulate the clinical hemodynamic state of atherosclerotic stroke. and it is an ideal model for studying the hemodynamic cerebral ischemia in posterior circulation.

Coronary-subclavian steal syndrome presenting with chest pain and syncope.

The present case is a 68-year-old patient with complaints of chest pain and syncopal attacks during physical activity of the left arm, for the last six months. He had a coronary artery bypass graft operation 10 years ago. Angiographic examination demonstrated total occlusion of the subclavian artery. The subclavian artery was stealing blood from the left anterior descending artery via the left internal mammary artery and from the brain via the left vertebral artery, leading to the diagnosis of subclavian artery steal syndrome; a rare cause of coronary and cerebral ischaemia.

Coronary-subclavian steal syndrome presenting with chest pain and syncope

The present case is a 68-year-old patient with complaints of chest pain and syncopal attacks during physical activity of the left arm, for the last six months. He had a coronary artery bypass graft operation 10 years ago. Angiographic examination demonstrated total occlusion of the subclavian artery.The subclavian artery was stealing blood from the left anterior descending artery via the left internal mammary artery and from the brain via the left vertebral artery, leading to the diagnosis of subclavian artery steal syndrome; a rare cause of coronary and cerebral ischaemia

Subclavian artery steal syndrome: treatment by percutaneous transluminal angioplasty.

We present our experience with 24 patients in whom percutaneous transluminal angioplasty was performed in the proximal subclavian artery. Seventeen patients had symptoms of subclavian steal syndrome, and seven had symptoms of upper extremity ischemia. Eighteen (75%) had excellent clinical results, with 80-100% restoration of the expected lumen diameter. Three patients required repeat dilatation because of recurrent symptoms. The only complication was a single case of brachial artery occlusion. Our results suggest that subclavian artery angioplasty is a safe and effective method for treating subclavian artery steal syndrome and upper extremity ischemia.

Successful Repair of Acute Traumatic Left Subclavian Artery Steal Syndrome

Successful Repair of Acute Traumatic Left Subclavian Artery Steal Syndrome

Right aortic arch with subclavian steal syndrome (atresia of left common carotid and left subclavian arteries)

A case is presented which demonstrates a right aortic arch with only one functional branch arising from the arch of the aorta. This single branch represented a right innominate artery giving rise to the right common carotid and right subclavian arteries. A review of the literature has failed to reveal a similiar maldevelopment of the aortic arch. It is postulated that this patient's symptoms in the left arm were secondary to inadequate blood flow and that her cerebral symptoms were secondary to a subclavian artery steal mechanism [14–20] as a result of a congenital abnormality. The reversal of flow compatible with a subclavian artery steal syndrome was demonstrated on the preoperative anterior aortogram which revealed retrograde filling of the left vertebral and subclavian arteries.