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Relevance of basilar artery study in patients with subclavian steal phenomenon.

Garcia-Antelo MJ, Puy-Nuñez A, Ayo-Martin O, Segura T - Open Neurol J (2011)

Bottom Line: The tests promoted reverse flow in the right VA, loss of diastolic flow in the left VA and interestingly, the normal anterograde BA flow became retrograde.Although subclavian steal is likely to be an innocuous phenomenon for the majority of our patients, it is probable that the presence of a hemodynamic effect on the basilar artery may identify those who are at special risk of neurologic symptoms.So, we recommend TCD study in all patients suffering SSP to rule out the possibility of a BA steal phenomenon.

View Article: PubMed Central - PubMed

Affiliation: Hospital Universitario A Coruña, A Coruña, Spain.

ABSTRACT
A 72-year-old male presented to the emergency department with gait instability and unclear speech. Computed tomography of the brain showed old lacunar infarcts in basal ganglia. Transcranial Doppler (TCD) sonography was normal. Extracranial Duplex sonography showed indirect hemodynamic signs of bilateral subclavian artery stenosis and both vertebral arteries also showed delayed systolic flow increase. A bilateral subclavian steal phenomenon was suspected, and arm compression tests was performed. The tests promoted reverse flow in the right VA, loss of diastolic flow in the left VA and interestingly, the normal anterograde BA flow became retrograde. Although subclavian steal is likely to be an innocuous phenomenon for the majority of our patients, it is probable that the presence of a hemodynamic effect on the basilar artery may identify those who are at special risk of neurologic symptoms. So, we recommend TCD study in all patients suffering SSP to rule out the possibility of a BA steal phenomenon.

No MeSH data available.


Related in: MedlinePlus

Extracranial color Duplex study of vertebral arteries before (left side), during (middle position), and upon completion (right position) of the arm compression test. Right VA (upper images) reveals initial anterograde flow that became retrograde after cuff release. Left VA (lower images) also shows initial anterograde flow with loss of diastolic flow at the end of the test.
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Figure 1: Extracranial color Duplex study of vertebral arteries before (left side), during (middle position), and upon completion (right position) of the arm compression test. Right VA (upper images) reveals initial anterograde flow that became retrograde after cuff release. Left VA (lower images) also shows initial anterograde flow with loss of diastolic flow at the end of the test.

Mentions: Transcranial Doppler ultrasound was normal. Extracranial Duplex ultrasound showed diffuse cervical atheromatosis including non-relevant (< 50%) carotid plaques and indirect hemodynamic signs of bilateral subclavian artery (SA) stenosis (delayed increase in systolic flow with monophasic flow profile instead of a normal triphasic profile). Interestingly, both vertebral arteries (VA) also showed delayed systolic flow increase (Fig. 1). A bilateral subclavian steal phenomenon was then suspected and arm compression test with a blood-pressure cuff was performed. The test was repeated on both arms; release of the pressure cuff led to reverse flow in the right VA and loss of diastolic flow in the left VA (Fig. 1). The arm compression test was repeated because of the patient's neurological symptoms while we recorded basilar artery (BA) waveforms (Fig. 2) by means of transcranial Doppler. The normal anterograde BA flow became retrograde following the causative ischemia test in either arm (Fig. 2).


Relevance of basilar artery study in patients with subclavian steal phenomenon.

Garcia-Antelo MJ, Puy-Nuñez A, Ayo-Martin O, Segura T - Open Neurol J (2011)

Extracranial color Duplex study of vertebral arteries before (left side), during (middle position), and upon completion (right position) of the arm compression test. Right VA (upper images) reveals initial anterograde flow that became retrograde after cuff release. Left VA (lower images) also shows initial anterograde flow with loss of diastolic flow at the end of the test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3106363&req=5

Figure 1: Extracranial color Duplex study of vertebral arteries before (left side), during (middle position), and upon completion (right position) of the arm compression test. Right VA (upper images) reveals initial anterograde flow that became retrograde after cuff release. Left VA (lower images) also shows initial anterograde flow with loss of diastolic flow at the end of the test.
Mentions: Transcranial Doppler ultrasound was normal. Extracranial Duplex ultrasound showed diffuse cervical atheromatosis including non-relevant (< 50%) carotid plaques and indirect hemodynamic signs of bilateral subclavian artery (SA) stenosis (delayed increase in systolic flow with monophasic flow profile instead of a normal triphasic profile). Interestingly, both vertebral arteries (VA) also showed delayed systolic flow increase (Fig. 1). A bilateral subclavian steal phenomenon was then suspected and arm compression test with a blood-pressure cuff was performed. The test was repeated on both arms; release of the pressure cuff led to reverse flow in the right VA and loss of diastolic flow in the left VA (Fig. 1). The arm compression test was repeated because of the patient's neurological symptoms while we recorded basilar artery (BA) waveforms (Fig. 2) by means of transcranial Doppler. The normal anterograde BA flow became retrograde following the causative ischemia test in either arm (Fig. 2).

Bottom Line: The tests promoted reverse flow in the right VA, loss of diastolic flow in the left VA and interestingly, the normal anterograde BA flow became retrograde.Although subclavian steal is likely to be an innocuous phenomenon for the majority of our patients, it is probable that the presence of a hemodynamic effect on the basilar artery may identify those who are at special risk of neurologic symptoms.So, we recommend TCD study in all patients suffering SSP to rule out the possibility of a BA steal phenomenon.

View Article: PubMed Central - PubMed

Affiliation: Hospital Universitario A Coruña, A Coruña, Spain.

ABSTRACT
A 72-year-old male presented to the emergency department with gait instability and unclear speech. Computed tomography of the brain showed old lacunar infarcts in basal ganglia. Transcranial Doppler (TCD) sonography was normal. Extracranial Duplex sonography showed indirect hemodynamic signs of bilateral subclavian artery stenosis and both vertebral arteries also showed delayed systolic flow increase. A bilateral subclavian steal phenomenon was suspected, and arm compression tests was performed. The tests promoted reverse flow in the right VA, loss of diastolic flow in the left VA and interestingly, the normal anterograde BA flow became retrograde. Although subclavian steal is likely to be an innocuous phenomenon for the majority of our patients, it is probable that the presence of a hemodynamic effect on the basilar artery may identify those who are at special risk of neurologic symptoms. So, we recommend TCD study in all patients suffering SSP to rule out the possibility of a BA steal phenomenon.

No MeSH data available.


Related in: MedlinePlus