Subclavian Steal Syndrome

Severe or complete stenosis of the subclavian artery proximal to the origin of the vertebral artery may lead to reversal of flow within the ipsilateral vertebral artery to supply the distal subclavian artery and ipsilateral upper extremity. This condition, referred to as subclavian steal syndrome, may lead to reduced vertebrobasillar blood flow which may be accentuated during exercise of the affected extremity. Clinical presentation and symptoms vary and depend on the anatomy of the circle of

Mra Brachial Artery

Fig. 6. MRA in a patient with Takayasu arteritis and aneurysm formation (arrow) of the right brachial artery

Fig. 5. The MIP reconstruction of a CE 3D MRA dataset (Gd-BOPTA, 0.1 mmol/kg) shows atherosclerotic stenosis and occlusion (arrows) of the radial deep and superficial arch as well as occlusion of several metacarpal arteries (arrowheads) [Image courtesy of Dr. G. Schneider]

Fig. 6. MRA in a patient with Takayasu arteritis and aneurysm formation (arrow) of the right brachial artery

Willis and the patency of the carotid system. Often collateral blood supply via the thyrocervical trunk, internal mammary artery, and branches of the external carotid and intercostal arteries may also be present.

Subclavian steal syndrome is most often an acquired condition, commonly due to atherosclerosis. Other potential causes are chest trauma, extrinsic compression by fibrosis or tumor, arteritis (Takayasu), radiation fibrosis, and fibrodysplasia. It can be congenital, such as in association with coarctation of the aorta, hypoplasia of the transverse aortic arch or proximal subclavian arteries, or coarctation of the aorta with aberrant branching of the subclavian artery. In 75% of patients, the left side is involved. With CE MRA stenosis or occlusion in the proximal subclavian artery can be demonstrated (Fig. 7). During the same exam, phase contrast velocity mapping can be used to document retrograde flow in the vertebral arteries (i.e. subclavian steal) [13].

Subclavian Steal

Fig. 7. MRA findings in a patient with severe atherosclerosis. The MIP image of the aortic arch reveals a common origin of both carotid arteries (blackarrow) with severe stenosis of the right and occlusion of the left carotid artery. Furthermore, occlusion of the left brachiocephalic artery (white arrow) and steal in the left vertebral artery can be seen

Fig. 7. MRA findings in a patient with severe atherosclerosis. The MIP image of the aortic arch reveals a common origin of both carotid arteries (blackarrow) with severe stenosis of the right and occlusion of the left carotid artery. Furthermore, occlusion of the left brachiocephalic artery (white arrow) and steal in the left vertebral artery can be seen

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  • tewelde
    What mra do you do for subclavian artery stenosis?
    8 years ago

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