Download PDF
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(02): e120-e124
DOI: 10.1055/s-0040-1719000
Original Article | Artigo Original

Endovascular Treatment in the Subclavian Steal Syndrome: Series of 29 Patients

Tratamento endovascular na síndrome do roubo da subclávia: Série de 29 pacientes
Luana Antunes Maranha Gatto 
1   Department of Neurosurgery and Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
,
Diego do Monte Rodrigues Seabra 
1   Department of Neurosurgery and Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
,
Gabriel Angelo Garute Zenatti 
1   Department of Neurosurgery and Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
,
Letícia Frose 
1   Department of Neurosurgery and Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
,
Gelson Luis Koppe
1   Department of Neurosurgery and Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
,
Zeferino Demartini Junior
1   Department of Neurosurgery and Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Subclavian steal syndrome is a group of symptoms resulting from retrograde flow in the vertebral artery, “stealing” blood from the posterior intracranial circulation and other territories, caused by stenosis or occlusion of the subclavian artery proximal to the origin of the same vertebral artery, or even of the brachiocephalic trunk. Most of the time, it is an incidental finding in patients with other conditions or cerebrovascular risk factors. We report a series of 29 patients with an angiographic diagnosis, in which 7 received treatment (all endovascular), all with symptoms directly related to this condition. Advanced age, systemic arterial hypertension, diabetes mellitus, smoking and stroke were comorbidities frequently related. Six patients improved completely after the procedure and one remained with vertigo.

Resumo

A síndrome do roubo de subclávia é um grupo de sintomas decorrente de fluxo retrógrado na artéria vertebral, “roubando” o sangue da circulação posterior intracraniana e de outros territórios, causado por estenose ou oclusão da artéria subclávia proximal à origem da mesma artéria vertebral, ou mesmo do tronco braquiocefálico. Na maioria das vezes, trata-se de um achado incidental em pacientes com outras condições ou fatores de risco cerebrovasculares. Relatamos uma série de 29 pacientes com diagnóstico angiográfico, em que 7 receberam o tratamento (todos via endovascular), todos com sintomas diretamente relacionados a essa condição. Idade avançada, hipertensão arterial sistêmica, diabetes mellitus, tabagismo e acidente vascular cerebral foram comorbidades frequentemente relacionadas. Seis pacientes melhoraram totalmente após o procedimento e um permaneceu com vertigens.

Keywords

subclavian steal syndrome - arteriography - left side - angioplasty

Palavras-chave

síndrome do roubo de subclávia - arteriografia - lado esquerdo - angioplastia


Publication History

Received: 19 May 2020

Accepted: 24 August 2020

Article published online:
15 February 2021

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Contorni L. [The vertebro-vertebral collateral circulation in obliteration of the subclavian artery at its origin]. Minerva Chir 1960; 15: 268-271
    PubMedGoogle Scholar
  • 2 Saha T, Naqvi SY, Ayah OA, McCormick D, Goldberg S. Subclavian Artery Disease: Diagnosis and Therapy. Am J Med 2017; 130 (04) 409-416
    CrossrefPubMedGoogle Scholar
  • 3 Bradaric C, Kuhs K, Groha P. et al. Endovascular therapy for steno-occlusive subclavian and innominate artery disease. Circ J 2015; 79 (03) 537-543
    CrossrefPubMedGoogle Scholar
  • 4 Wrotniak L, Kabłak-Ziembicka A, Rosławiecka A. et al. Resolution of ischemic symptoms after percutaneous angioplasty for a symptomatic subclavian artery stenosis. J Vasc Surg 2016; 64 (03) 684-691
    CrossrefPubMedGoogle Scholar
  • 5 Osiro S, Zurada A, Gielecki J, Shoja MM, Tubbs RS, Loukas M. A review of subclavian steal syndrome with clinical correlation. Med Sci Monit 2012; 18 (05) RA57-RA63
    CrossrefPubMedGoogle Scholar
  • 6 Fisher CM. A new vascular syndrome - “the subclavian steal. N Engl J Med 1961; 265: 912-913
    CrossrefPubMedGoogle Scholar
  • 7 Reivich M, Holling HE, Roberts B, Toole JF. Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. N Engl J Med 1961; 265: 878-885
    CrossrefPubMedGoogle Scholar
  • 8 Karpenko A, Starodubtsev V, Ignatenko P, Gostev A. Endovascular Treatment of the Subclavian Artery Steno-Occlusive Disease. J Stroke Cerebrovasc Dis 2017; 26 (01) 87-93
    CrossrefPubMedGoogle Scholar
  • 9 Labropoulos N, Nandivada P, Bekelis K. Prevalence and impact of the subclavian steal syndrome. Ann Surg 2010; 252 (01) 166-170
    CrossrefPubMedGoogle Scholar
  • 10 Potter BJ, Pinto DS. Subclavian steal syndrome. Circulation 2014; 129 (22) 2320-2323
    CrossrefPubMedGoogle Scholar
  • 11 Gatto LAM, Chaves JPG, Mendes CH, Seabra DMR, Koppe GL, Demartini Jr Z. Endovascular Treatment in the Subclavian Steal Syndrome - Tratamento endovascular na síndrome do roubo da subclávia. Arq Bras Neurocir 2019; 38: 137-140
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Ochoa VM, Yeghiazarians Y. Subclavian artery stenosis: a review for the vascular medicine practitioner. Vasc Med 2011; 16 (01) 29-34
    CrossrefPubMedGoogle Scholar
  • 13 Hass WK, Fields WS, North RR, Kircheff II, Chase NE, Bauer RB. Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. JAMA 1968; 203 (11) 961-968
    CrossrefPubMedGoogle Scholar
  • 14 De Vries JP, Jager LC, Van den Berg JC. et al. Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long-term results. J Vasc Surg 2005; 41 (01) 19-23
    CrossrefPubMedGoogle Scholar
  • 15 English JA, Carell ES, Guidera SA, Tripp HF. Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization. Catheter Cardiovasc Interv 2001; 54 (01) 8-11
    CrossrefPubMedGoogle Scholar
  • 16 Fregni F, Castelo-Branco LEC, Conforto AB. et al. Treatment of subclavian steal syndrome with percutaneous transluminal angioplasty and stenting: case report. Arq Neuropsiquiatr 2003; 61 (01) 95-99
    CrossrefPubMedGoogle Scholar
  • 17 Law MM, Colburn MD, Moore WS, Quiñones-Baldrich WJ, Machleder HI, Gelabert HA. Carotid-subclavian bypass for brachiocephalic occlusive disease. Choice of conduit and long-term follow-up. Stroke 1995; 26 (09) 1565-1571
    CrossrefPubMedGoogle Scholar