Subclavian steal syndrome

In severe occlusive disease of the subclavian artery (SCA) blood supply of the arm is mainly provided by reversed flow through the vertebral artery (VA) arising behind the obstruction. The so-called subclavian-steal syndrome consists of ischemic symptoms in the arm, especially after exercise, such as pain or numbness or coolness (Reivich et al. 1961). Consequently a diminished or delayed pulse in the radial artery or decreased blood pressure on the side of SCA stenosis can be palpated. Rarely neurological symptoms such as spells of dizziness may be brought about by exercise ofthe arm. Even more rare are ischemic brainstem strokes in subclavian-steal syndrome (Bornstein and Norris 1986). 

Fig. 6.15 Slow flow or subclavian steal syndrome. 2D TOF MRA source image (a) and MIP image of the TOF MRA (b) show absent flow and possible occlusion of the left vertebral artery (arrows in b). ceMRA (c), however, shows flow in this...

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