Steal phenomenon

Myocardial ischemia is unusual during infusion of iloprost. It mainly occurs in patients with pre-existing coronary disease, when it is ascribed to a steal phenomenon... 

Cheshire WP, Santos CC, Massey EW et al. (1996). Spinal cord infarction aetiology and outcome. Neurology 47 321-330 Cho HJ, Song SK, Lee DW et al. (2007). Carotid-subclavian steal phenomenon. Neurology 68 702... 

Spiral (helical) CT. Radiology 189 647-656 Hennerici M, Klemm C, Rautenberg W (1988). The subclavian steal phenomenon a common... 

Myocardial ischemia is unusual during infusion of iloprost. It mainly occurs in patients with pre-existing coronary disease, when it is ascribed to a steal phenomenon detrimental to the subendocardial tissue. As a rule it is transient and exceptionally proceeds to infarction. However, such an event has now been reported in a patient with systemic sclerosis (7). 

Because of its natriuretic and vasodilative activity, in addition to its effect on the intracellular ATP-concen-tration [129], ANF seems to be a good candidate for the prevention of CMIN. To date no conclusive beneficial results have been obtained in clinical studies [40,104, 130]. This may be due to the route of application (i.v. versus i.a. in experimental studies) and to intrarenal hemodynamic changes caused by ANF with induction of an arterial-steal phenomenon. 

Most frequent clinical presentations of brain AVMs are hemorrhage, seizure, chronic headache and focal deficits not related to hemorrhage (e.g. steal phenomenon)... 

Hemodynamic stress can be mimicked by using a tolerance test such as acetazolamide administration in conjunction with quantitative measurement of CBF. Although the exact mechanism of action is uncertain, acetazolamide causes vasodilatation of normal cerebral arteries and an increase in CBF in the corresponding territory. Patients with impaired cerebrovascular reserve, however, are aheady maximally vasodilated due to the response of cerebral autoregulatory mechanisms, and thus cannot respond further to acetazolamide. CBF does not increase, but remains stable or even decreases, because of a steal phenomenon by the healthy arteries (Nariai et al. 1995). Acetazolamide is generally well tolerated, with the most common side effects being cir-cumoral numbness, paresthesias, and headache. One case of acetazolamide-associated reversible ischemia has been reported (Komiyama et al. 1997). 

ANS First of all, we have no model, in the sense that it is being used in this conference. Steal, in the usual vascular sense, only occurs in the presence of a stenosis. There are steal phenomenon which also include a collateral vessel. The principle is the same. That is, there are two resistors distal to a third stenosis upstream and those two resistors interact because there is a pressure drop across the upstream stenosis. It can cause subclavean steal, for example, where there are cerebral effects or it can cause transmural steal in the heart. That is, if there is a coronary stenosis, the epicardium steals from the endocardium and therefore the inner/outer ratio is below unity. This is thought of as a steal phenomenon. 

JARON Is there a kind of critical stenosis which initiates the steal phenomenon ... 

Regadenoson has an improved side effect profile in comparison to adenosine and dipyridamole. However, it may also precipitate myocardial infarction. This adverse effect is secondary to coronary steal phenomenon induced by regadenoson administration. Most likely, in this mechanism A2A vasodilatation causes intercoronary and transmxual steal phenomenon which in the presence of a preexisting stenotic lesion results in myocardial infarction [6]. 

Fig. 3.27a,b. Post-biopsy arteriovenous fistula with steal phenomenon, a Color flow sonography on the lower pole of the graft shows an arteriovenous fistula with increased velocities and spectral broadening on spectral waveform, b Arterial flow at the upper pole is characterized by a holodiastolic reflux due to a steal phenomenon, which disappeared after embolization of the shunt... 

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