Ultraschall in Med
DOI: 10.1055/a-0864-7124
Pictorial Essay
© Georg Thieme Verlag KG Stuttgart · New York

Vascular Ultrasonography Analysis of the Steal Phenomena Following Common Carotid Artery Obstruction

Vaskuläre Sonografie-Analyse der Steal-Phänomene nach einer Obstruktion der Halsschlagader
Jiong Wang
1  Department of Medical Ultrasonography, Peking University International Hospital, Beijing, China
2  Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
,
Ye Zheng
2  Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
,
Tian Wang
3  Department of Rheumatology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
,
Yongmei Wang
4  Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
,
Jaclyn Wu
5  Medical school, Ohio State University College of Medicine, Columbus, United States
,
Xiaomei Zhu
1  Department of Medical Ultrasonography, Peking University International Hospital, Beijing, China
,
Lianjie Shi
6  Department of Rheumatology, Peking University International Hospital, Beijing, China
,
Nan He
7  Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
,
Yueh Z. Lee
8  Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, United States
› Author Affiliations
Further Information

Publication History

25 November 2018

21 February 2019

Publication Date:
20 March 2019 (eFirst)

Introduction

High-grade stenotic or occlusive diseases of the common carotid artery (CCA) are not rare in clinical practice and can be seen in diverse cardiovascular diseases, including atherosclerosis, vasculitis, thrombosis, dissection etc. Collateral circulation often forms secondary to these obstructive lesions to maintain cerebral perfusion. Herein, we describe and analyze nine patients ([Table 1]) with a rare hemodynamic phenomenon “CCA steal”, resulting from severe obstructive diseases of the CCA, or both the right CCA and innominate artery (INA).

Table 1

General patient information, clinical manifestations and corresponding types of CCA steal.

patient

gender

age, y

diagnosis

history

symptoms

clinical sign

clinical stages of TA

type of CCA steal

initial workup

follow-up

1

M

55

AS with TH

1 – 6 m

transient dizziness, intermittently transient motor weakness of the right upper and lower extremities

no obvious sign

complete

2

F

41

TA

> 20 yrs

dizziness, vertigo, weakness and claudication of the right upper extremities, carotodynia

pulse deficit at the right upper extremities

quiescent

quiescent/relapse

partial, transient complete

3

F

51

TA

> 2 yrs

transient dizziness, headache, weakness

hypertension

active

active/alleviation

partial, transient complete

4

F

42

TA

> 30 yrs

carotodynia, weakness and claudication of the left upper extremities

left cervical bruits, pulse deficit at the left upper extremities

quiescent

NF

partial, transient latent

5

F

40

TA

5 yrs

dizziness, weakness and claudication of the left upper extremities

pulse deficit at the left upper extremities

active

quiescent

partial, transient latent

6

F

32

TA

> 3 yrs

dizziness, weakness and claudication of the bilateral upper extremities

pulse deficit at the bilateral upper extremities

active

quiescent

latent

7

F

22

TA

6 yrs

dizziness, syncope, amaurosis fugax, jaw claudication, weakness and claudication of the right upper extremities

pulse deficit at the right upper extremities

active

quiescent

latent

8

F

60

TA

> 40 yrs

dizziness, vertigo, syncope, amaurosis fugax, jaw claudication, weakness and claudication of the bilateral upper extremities

pulse deficit at the bilateral upper extremities, bruit at the left cervical region

quiescent

quiescent, TH in AVs

latent

9

M

43

TA

> 18 yrs

dizziness, vertigo, arthralgia, weakness and claudication of bilateral upper extremities

pulse deficit at the bilateral upper extremities

quiescent

quiescent

latent

M: month; y: year-old; yrs: years; AS: atherosclerosis; TH: thrombosis; TA: Takayasu arteritis; –: not TA; NF: no follow-up; AVs: artificial vessels.