Subclavian Steal Syndrome

Introduction Subclavian steal syndrome (SSS) occurs when severe narrowing or blockage of the proximal subclavian artery leads to reversed blood flow in the ipsilateral vertebral artery [1]. This reversal redirects blood away from the brain to supply the affected arm, which has lower arterial pressure and may present with neurological symptoms. However, some cases are asymptomatic [2]. Case Presentation A 71-year-old patient with peripheral artery disease and AH, complained of right arm weakness, dizziness, blurred vision and ataxia was evaluated for a possible neurodegenerative or demyelinating process. After detecting acute ischemic findings brain MRI was performed, the patient was hospitalized. An ischemic stroke in the left posterior cerebral artery was diagnosed, along with chronic ischemic changes. Neck ultrasound was performed, and steal syndrome was suspected. Angiography confirmed SSS from right to left through the a. vertebralis and occlusion of the a. subclavia sin. Due to the occlusion and SSS, an interventional radiologist was consulted regarding recanalization and PTA. However, due to technical limitations - lack of access via the arm - endovascular treatment couldn’t be performed. Therefore, a right to left subclavian-subclavian shunt (8 mm prosthesis) operation was done without complications. On the 5th postoperative day, in good therapeutic condition, the patient was discharged for further outpatient treatment and rehabilitation. Discussion SSS is characterized by retrograde blood flow in the vertebral arteries due to stenosis or occlusion of the subclavian artery. The primary cause of SSS is atherosclerosis. Patients typically presents with symptoms such as dizziness, arm weakness, ataxia or even vertebrobasilar insufficiency. Reversed vertebral artery flow is often detected incidentally through duplex ultrasound. [3]. Further evaluation of the condition may require imaging like MRA or CTA. Modern treatment approaches favor endovascular techniques, such as balloon angioplasty. However, if endovascular options are unavailable, surgical alternatives like bypass or transposition techniques can be considered [4]. Conclusions SSS is an insidious disease with a 2.5% incidence rate. Most cases are asymptomatic and some present with neurological symptoms [5]. Endovascular treatment is considered a better choice than bypass [6].