Modern MDCT technics in diagnosis of subclavian steal syndrome

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Congress:

ECR 2015

Poster Number:

C-2508

Type:

Educational Exhibit

Keywords:

Obstruction / Occlusion, Education and training, Arteriosclerosis, Imaging sequences, Diagnostic procedure, Contrast agent-intravenous, CT-Quantitative, CT-Angiography, CT, Vascular, Neuroradiology brain, Arteries / Aorta

Authors:

A. V. Vishnevskaia, E. Kondratyev, A. Sidorov, S. A. Buryakina, G. Karmazanovsky; Moscow/RU

DOI:

10.1594/ecr2015/C-2508

DOI-Link:

https://dx.doi.org/10.1594/ecr2015/C-2508

Fig. 1: I Type : the arch vessels arise next to each other from arch in the same...

Fig. 2: II Type : the brahiocephalic vessels arise not far from each other. The...

Fig. 3: III Type; the arch vessels arise far apart. The distance from the...

Fig. 4: The brachiocephalic trunk and the left CCA have a common origin.

Learning objectives

To describe and to illustrate essential features and diagnostic clue detected by MDCT-angiography and brain MDCT-perfusion in case of diagnosed subclavian steal syndrome.

Background

The subclavian steal syndrome (SSS)consist of significant obstruction or occlusion proximal subclavian artery segment and retrograde flow in ipsilateral vertebral artery (subclavian steal fenomenon) associated with cerebral ischemic symptoms. The cerebral symptoms of SSS could include paroxysmal vertigo and drop attacks, but SSS might be asymptomatic too, with arm claudication only. [1] Among different reasons of SSS the most common is atherosclerotic vessel disease. Atherosclerotic plaques diagnosed in more then 90% of cases of SSS. Other reasons include Takayasu arteritis, vasculitis, neurofibromatosis, thoracic aortic dissection,...

Findings and procedure details

Patients with diagnosed subclavian steal syndrome underwent 256-MDCT-angiography before planed endovascular treatment. At first we qualifyed arch elongation and arch vessel configuration with aims of to recognize the type of aortic arch. There are three types of aortic arches but some authors have also suggested a type IV. I Type : the arch vessels arise next to each other from arch in the same horizontal plane (Fig.1). II Type : the brahiocephalic vessels arise not far from each other (Fig.2). The distance from the brachiocephalic...

Conclusion

The major role of MDCT-angiography in diagnostic of subclavian steal syndrome is to define supra-aortic vessel anatomy for optimal planning endovascular treatment and detecting abnormalities in a region out of reach of ultrasonography. Brain MDCT- perfusion can be applied for estimation of nonspecific appearance of cerebral ischemic.

Personal information

References

1. Osiro S, Zurada A. A review of subclavian steal syndrome with clinical correlation. Med Sci Monit, 2012: 18(5): RA57-63. 2. Park H, Kim H, Jin Cha M, Lee J, Koh I, Nam H. A Case of Cerebellar Infartion Caused by Acute Subclavian Thrombus Following Minor Trauma. Yonsei Med J 2013; 54(6): 1538-1541. 3. Contorni L. The vertebro-vertebral collateral circulation in obliteration of the subclavian artery at its origin. Minerva Chir. Mar 15 1960;15:268-71 4. Alcocer F, David M. A forgotten vascular disease with important...