Doppler ultrasonography of the ipsilateral vertebral artery with high-grade stenosis of the subclavian artery: a series of 12 cases

Abstract

Introduction : Proximal stenosis of the subclavian artery (SCA) shows progression to subclavian steal syndrome (SSS)/phenomenon (SSP), characterized by retrograde flow in the ipsilateral vertebral artery (VA). Here we describe the clinical manifestations and ultrasound findings of ipsilateral VA in patients with high-grade stenosis of the SCA, and the role of VA ultrasound in percutaneous transluminal angioplasty (PTA) stenting of the SCA. Patients : Twelve patients (male: 10, female: 2; age: 17–86 yr) were selected from among inpatients with SCA stenosis treated in our department between 2009 and 2015. Results : The affected vessel was the left in 8 cases and the right in 4. The causes of stenosis were atherosclerosis in 10 cases, congenital in 1, and arteritis in 1. The symptoms were dizziness, faintness, syncope, diplopia, dysar-thria, rest pain, coldness and arm claudication on effort. The cases were divided into SSS (n=7), SSP (n=2), and SCA stenosis only (n=3). The Doppler flow patterns were classified as normal antegrade (n=3), bunny waveform (n=0), alternating (n=6), reverse (n=2), and not detected (n=1). Ten of the patients underwent PTA stenting and 2 conservative therapy. Conclusions : Alternating and reverse flow patterns in the VA might lead to the surgical indication for PTA-stenting of SCA.