Color Doppler Flow Imaging Study in a Patient with Subclavian Steal Syndrome Associated with Internal Carotid Artery Occlusion: A Case Report

Abstract

We present a case of 64 year-old man with subclavian steal syndrome associated with internal carotid artery occlusion. We evaluated flow velocity of bilateral vertebral arteries, carotid arteries, and ophthalmic arteries with color Doppler flow imaging (CDFI). CDFI revealed to-and-fro flow in the right vertebral artery, which was enhanced with right-arm exercise. And we confirmed increased flow velocity of the contralateral left vertebral artery with a right-arm task. The left internal carotid artery was occluded and the ophthalmic artery flowed in the reverse direction. Angiography confirmed a severe right subclavian artery stenosis and reversed flow of the right vertebral artery. The left internal carotid artery was occluded and fed through the left posterior communicating artery. After angioplasty using balloon-expandable stent, flow direction was normalized immediately. Follow-up CDFI showed normograde flow of both vertebral arteries, and left ophthalmic artery flow changed to the to-and-fro pattern. We discuss the flow velocity changes of both vertebral arteries and ophthalmic artery after arm task and treatment.