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Hafiz Rizwan Talib Hashmi, Eddy De Jesus, Misbahuddin Khaja
(Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA)
Med Sci Case Rep 2016; 3:8-12
Subclavian steal syndrome is a form of peripheral artery disease which may be a marker of underlying diffuse atherosclerotic disease. It can manifest as symptomatic ischemia affecting the upper extremities, and in some cases the brain and heart are affected. The condition remains overlooked and therefore underdiagnosed.
CASE REPORT: Here, we present the case of a 63-year-old man who came for evaluation of left-sided weakness and progressively worsening dizziness upon waking. He was found to have unequal blood pressure in both arms. Carotid Doppler demonstrated bidirectional flow in the left cerebral artery, with suspicion of subclavian steal phenomenon. A computed tomography (CT) angiogram showed focal hemodynamically significant stenosis within the left subclavian artery. The patient underwent percutaneous angioplasty with stenting of the left subclavian artery leading to complete resolution of symptoms.
CONCLUSIONS: Subclavian stenosis can be readily recognized by duplex ultrasound. High index of suspicion and prompt clinical recognition followed by endovascular intervention in atypical cases can prevent untoward outcomes associated with this disease.