Doppler ultrasonography of the ipsilateral vertebral artery with high-grade stenosis of the subclavian artery: a series of 12 cases

Abstract

Introduction: Proximal stenosis of the subclavian artery (SCA) shows progression to subclavian steal syndrome (SSS)/phenomenon (SSP), characterized by retrograde flow in the ipsilateral vertebral artery (VA). Here we describe the clinical manifestations and ultrasound findings of ipsilateral VA in patients with high-grade stenosis of the SCA, and the role of VA ultrasound in percutaneous transluminal angioplasty (PTA) stenting of the SCA.
Patients: Twelve patients (male: 10, female: 2; age: 17–86 yr) were selected from among inpatients with SCA stenosis treated in our department between 2009 and 2015.
Results: The affected vessel was the left in 8 cases and the right in 4. The causes of stenosis were atherosclerosis in 10 cases, congenital in 1, and arteritis in 1. The symptoms were dizziness, faintness, syncope, diplopia, dysarthria, rest pain, coldness and arm claudication on effort. The cases were divided into SSS (n=7), SSP (n=2), and SCA stenosis only (n=3). The Doppler flow patterns were classified as normal antegrade (n=3), bunny waveform (n=0), alternating (n=6), reverse (n=2), and not detected (n=1). Ten of the patients underwent PTA stenting and 2 conservative therapy.
Conclusions: Alternating and reverse flow patterns in the VA might lead to the surgical indication for PTA-stenting of SCA.