Abstract
Numerous operative procedures and percutaneous transluminal angioplasty (PTA) have been proposed for the correction of subclavian syndrome (SSS). We report a case of subclavian steal syndrome with occlusion of the carotid artery that had lateralizing hemispheric focal events.
A 51-year-old male was admitted to our hospital due to right hemiparesis, transcortical sensory aphasia and left arm claudication. Aphasia worsened with right arm physical movement. Blood pressure measured in the right upper limb was 30 mmHg lower than in the opposite side. CT scan and MRI showed infarction in the cortical territory left of the middle cerebral artery. Angiograms revealed complete occlusion of the left carotid artery, and severe stenosis of the right proximal subclavian artery. The left hemisphere was mainly perfused from the vertebral artery via the circle of Willis. STA-MCA anastomosis was performed.
After surgery, the patient was free from any symptoms. SPECT (123I-IMP) performed before and after the operation demonstrated recovery of CBF in the left middle cerebral artery area. The present case suggests that STA-MCA anastomosis should be the first treatment of choice for subclavian steal syndrome with lateralizing hemispheric focal events.
