Cerebral angiography in anterior circulation ischemic stroke with bilateral subclavian artery occlusion in subclavian steal syndrome: A case report and literature review

Introduction: Subclavian steal syndrome (SSS) is a hemodynamic phenomenon that occurs when a total occlusion in the subclavian artery (SA) proximal to the vertebral artery (VA) causes retrograde flow in the ipsilateral VA. Subclavian steal syndrome with total occlusion of bilateral SA is a very rare case. Case Report: A 60-year-old woman reported experiencing sudden weakness on the right side of her body for eight days. Previously, the patient often felt shaky and cramped in his right and left hands. After a head computed tomography (CT) without contrast was performed, an infarct was found in the left centrum semiovale, left corona radiata, left posterior and anterior cornu periventricular, and right side of the pons. After cerebral digital subtraction angiography (C-DSA) was carried out, total occlusion of the bilateral SA was found, stenosis of the left M1 segment of the middle cerebral artery (MCA) branch. Conclusion: Bilateral total occlusion of the SA is a very rare case and has rarely been reported before. In several studies, cases of unilateral SA occlusion resulted in SSS which provides an illustration of the reverse mechanism of blood vessel flow from the contralateral side of the occlusion. This backflow usually occurs in the contralateral vertebral artery. However, in this case, bilateral SA occlusion occurred so that there was no backflow mechanism in the VA. As compensation for the vascularization of the posterior circulation, collateral formation occurs from the external carotid artery (ECA) to the VA. However, this process causes a supply of blood flow to the anterior circulation, resulting in an anterior ischemic stroke.