Subclavian steal syndrome: an underdiagnosed disease

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2017

Poster Number:

C-0753

Type:

Educational Exhibit

Keywords:

Arteries / Aorta, Cardiovascular system, Head and neck, MR-Angiography, CT-Angiography, Ultrasound-Spectral Doppler, Education, Arteriosclerosis, Education and training, Haemodynamics / Flow dynamics

Authors:

R. O. Martins¹, M. C. Calegari², M. Lopes³, L. Santos ⁴, L. Cruz ⁴, R. Vasconcelos ⁴, M. Natal³; ¹Brasília, Di/BR, ²Brasília, DF/BR, ³Brasília/BR, ⁴Brasilia /BR

DOI:

10.1594/ecr2017/C-0753

DOI-Link:

https://dx.doi.org/10.1594/ecr2017/C-0753

Fig. 1: 72 year-old female presented with dizziness, Axial gradient echo time of flight...

Fig. 2: 35 year-old female with Takayasu arteritis, presenting ischemic stroke in...

Fig. 3: Doppler scan ultrasonography waveforms.

Learning objectives

The objective of this presentation is to review the teaching points of the subclavian steal syndrome (SSS); clinicalfindings and imaging features based on personal archive will be highlighted.

Background

Subclavian steal occurs due to the presence of subclavian artery stenosis before the emergence of the vertebral artery, most common in the origin of the aortic arch, leading to a retrograde flow through the ipsilateral vertebral artery and circle of Willis. When the steal is associated with neurologic symptoms is called “subclavian steal syndrome”. This diagnosis has to be suspected when there is a reduction of blood pressure on the affected arm by 15-20 mmHg. Most common symptoms include arm claudication occurring at regular intervals,...

Findings and procedure details

1 – MRA – Magnetic Resonance Angiography MRA methods, many of which are sensitive to direction of flow, offer an attractive alternative, for example, phase-contrast MRA methods inherently encode direction of flow and can show subclavian stenosis and reversal of flow in the vertebral artery. TOF MRA does not possess inherent flow-encode information but can show flow direction, as flow from one direction can be suppressed by a saturation pulse that facilitates generation of selective arterial or venous MR images. Although these techniques are suited...

Conclusion

In the past years the SSS has been an under diagnosed disease, but with the technology evolution and increased radiologist experience a higher number of cases have clearly raised the prevalence data. Early diagnosis can prevent drastic complications and highlight the importance of proper evaluation of the exam.

Personal information

References

1 – Kremmyda, O.; Holtmannspoetter M.. et al. Symptomatic Complete Vertebral Carotid Steal Syndrome Caused by Innominate Artery Stenosis anda n Arteriovenous Right Forearm Fistula. J Ultrasound Med 2011; 30:1599-1603. 2 – Potter, B.J.. PINTO. D.S. Subclavian Steal Syndrome. Circulation. 2014; 129:2320-2323. 3 – Oslro, S.; Zurada, A.. et al. A review of subclavian steal syndorme with clinical correaltion. Med Sci Monit, 2012: 18(5): RA 57-63. 4 – Romero, J. M.; Lev, M. H.. et al. US of Neurovascular Oclusive Disease: Interpretive Pearls and Pitfalls....