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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
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, traumatic subclavian artery occlusion or fistula and so on [1,2].
Diagnostic features of subclavian steal phenomenon have been well described in literature sins 1960 year,
while Contorni first described retrograde flow in the vertebral artery [3].
In recent years major part of studies focused on ultrasonography examinations,
because most patients with SSS are asymptomatic,
and diagnosed incidentally through routine carotid Doppler examination.
Color Doppler examinations evaluate type and intensity of retrograde flow,
and CT-angiography evaluate average enhancement of carotid arteries [4].
But CT angiography is necessary as the confirmatory examination for any suspected subclavian steal cases found on ultrasound examinations,
because not all retrograde vertebral flow seen on ultrasound examinations constitute true subclavian “steal”.
Sometimes the same symptoms may be due to proximal vertebral artery stenosis or occlusion or “kinking ” in proximal subclavian artery segments,
which is mainly important for planning of surgical treatment.
CT techniques can directly show the anatomical features of subclavian stenosis or occlusion,
and additionally any associated extracranial and intracranial stenosis [4,
5,
6].
Brain CT perfusion was one of the most widely applied diagnostic technique that allow quick and non-invasive estimation of cerebral blood circulation,
in cases of significant cerebral ischemic symptoms of any reasons,
include SSS.
[7]
We want to report most important MDCT-angiography signs,
which were compulsory for preoperative assessment and findings detected by brain MDCT-perfusion in series of patients with subclavian steal syndrome.