“ Severe stenosis of the proximal subclavian artery causes retrograde flow in the ipsilateral vertebral artery (to bypass the stenosis by co...
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Severe stenosis of the proximal subclavian artery causes retrograde flow in the ipsilateral vertebral artery (to bypass the stenosis by collaterals). In partial steal, there is antegrade flow in the vertebral artery in systole, with retrograde flow in diastole. Associated with cerebral ischaemic symptoms (e.g. vertigo, dizziness and syncope).
Mostly due to atherosclerosis, but also linked to vasculitis.
Mostly occurs on the left.
US
• Retrograde ipsilateral vertebral artery flow with evidence of a subclavian stenosis (parvus-tardus and monophasic waveform in the distal subclavian artery)
CT/MR ANGIOGRAPHY
• Subclavian stenosis/occlusion
• Delayed enhancement/retrograde flow in ipsilateral vertebral artery
INTERVENTION
• Angioplasty and stenting preferred to surgical bypass in symptomatic patients
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