American Journal of Neuroradiology

Classic Case

Section Editors:
Anvita Pauranik, MD, University of British Columbia, Vancouver, British Columbia, Canada
Michael Travis Caton, MD, Mount Sinai South Nassau, New York
Simona Gaudino, MD, Università Cattolica del Sacro Cuore, Italy
Matthew S. Parsons, MD, Mallinckrodt Institute of Radiology, Missouri
Anat Yahav-Dovrat, MD, University of Toronto, Canada

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November 30, 2015

Subclavian Artery Steal Syndrome

Figure Caption
The subclavian artery steal syndrome refers to a phenomenon of reverse flow in the vertebral artery ipsilateral to a hemodynamically significant stenosis/occlusion of the subclavian artery. While most patients are asymptomatic, others may present with cerebral arterial insufficiency and upper limb pain or temperature changes. Here the classic x-ray arch angiographic findings reveal total occlusion of the proximal segment of the left subclavian artery (arrow in A). Reversed (cephalocaudal) flow in the left vertebral artery to the left distal subclavian artery is seen on right vertebral injection of contrast medium in late arterial phase (arrow in B). The blood supply to the left upper limb is maintained by a patent vertebra-basilar system (arrow in C).