The authors present two patients, both 46-year-old males, with subclavian steal syndrome successfully treated by percutaneous transluminal angioplasty (PTA). One patient complained of fatigability of the right arm of several years' duration. Angiograms revealed irregular stenosis of the proximal subclavian artery. The second patient had suffered transient attacks of dizziness, dysesthesia of the left upper extremity that was exacerbated by exertion, and transient pain and pallor of the homolateral fingers. The last symptom indicated embolic blockage of the blood supply to the finger arteries. Both patients underwent PTA via the femoral artery, during which procedure the homolateral vertebral artery was occluded with a transbrachial balloon catheter in order to prevent an embolism entering the vertebral artery. No complications occurred, and both patients' clinical symptoms disappeared immediately after PTA. Angiograms obtained 3 months postoperatively demonstrated sufficient dilatation of the treated segments of the subclavian arteries and antegrade flow in the vertebral artery in both cases. Temporary balloon occlusion of the homolateral vertebral artery during PTA appears to be an appropriate means of preventing the migration of emboli into the vertebral artery.
