Kajihara S, Uozumi T, Sakoda K, Okamoto H, Sugiyama K, Yamaguchi T
No To Shinkei. 1985 Oct;37(10):979-84.
It has been known that significant narrowing of the subclavian or innominate artery may cause cerebrovascular ischemic symptoms, especially vertebrobasilar insufficiency. This condition has been named as the subclavian steal syndrome (SSS). Recently, percutaneous transluminal angioplasty (PTA) has been developed and used in treating occlusive vascular lesions. In this report, we presented a 61-year-old man who suffered from SSS and treated by PTA. He complained of dizziness and dysesthesia on his left upper extremity which got worse on exertion. The left radial pulse was diminished and the left brachial blood pressure was lower about 50 mmHg than the right. Bruits were recognized over the left suprasubclavicular area. Arch aortogram revealed an 80% stenosis of the proximal left subclavian artery and retrograde flow of the left vertebral artery on late arterial phase. PTA was successfully performed at the same time as angiography via the right femoral artery without any complications. His clinical symptoms improved immediately following PTA. A month after PTA, left retrograde vertebral angiogram demonstrated that the dilation of the treated segment of the left subclavian artery continuously remained. Because of several advantages such as a technical easiness and a more safety, PTA will be a useful therapeutic tool for not only SSS but also other obstructive diseases of brachiocephalic arteries prior to some surgical treatments. However, it is necessary to avoid some possible complications, especially embolism into the cerebral circulation in this technique, and the careful procedure should be done under the co-operation with vascular surgeons and radiologists.
