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Subclavian Steal Syndrome
T. Gregory Walker, MD, FSIR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Vertebral artery (VA) provides collateral blood flow to upper extremity because of vascular blockage
              • Caused by stenosis/occlusion of proximal subclavian artery (SCA) or, occasionally, brachiocephalic artery
                • Leads to reversed flow in VA to perfuse SCA distal to stenosis/occlusion
              • Exacerbated by demand for increased arterial blood flow in arm supplied by affected SCA

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Osiro S et al: A review of subclavian steal syndrome with clinical correlation. Med Sci Monit. 18(5):RA57-63, 2012
                                        2. Song L et al: Endovascular stenting vs. extrathoracic surgical bypass for symptomatic subclavian steal syndrome. J Endovasc Ther. 19(1):44-51, 2012
                                        3. Betensky BP et al: Unequal blood pressures: a manifestation of subclavian steal. Am J Med. 124(8):e1-2, 2011
                                        4. Tan TY et al: Hemodynamic effects of subclavian steal phenomenon on contralateral vertebral artery. J Clin Ultrasound. 34(2):77-81, 2006
                                        5. Sheehy N et al: Contrast-enhanced MR angiography of subclavian steal syndrome: value of the 2D time-of-flight "localizer" sign. AJR Am J Roentgenol. 185(4):1069-73, 2005
                                        6. Bitar R et al: MR angiography of subclavian steal syndrome: pitfalls and solutions. AJR Am J Roentgenol. 183(6):1840-1, 2004
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Definitions

                                                  • Vertebral artery (VA) provides collateral blood flow to upper extremity because of vascular blockage
                                                    • Caused by stenosis/occlusion of proximal subclavian artery (SCA) or, occasionally, brachiocephalic artery
                                                      • Leads to reversed flow in VA to perfuse SCA distal to stenosis/occlusion
                                                    • Exacerbated by demand for increased arterial blood flow in arm supplied by affected SCA

                                                IMAGING

                                                • General Features

                                                  • Ultrasonographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Angiographic Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Osiro S et al: A review of subclavian steal syndrome with clinical correlation. Med Sci Monit. 18(5):RA57-63, 2012
                                                                              2. Song L et al: Endovascular stenting vs. extrathoracic surgical bypass for symptomatic subclavian steal syndrome. J Endovasc Ther. 19(1):44-51, 2012
                                                                              3. Betensky BP et al: Unequal blood pressures: a manifestation of subclavian steal. Am J Med. 124(8):e1-2, 2011
                                                                              4. Tan TY et al: Hemodynamic effects of subclavian steal phenomenon on contralateral vertebral artery. J Clin Ultrasound. 34(2):77-81, 2006
                                                                              5. Sheehy N et al: Contrast-enhanced MR angiography of subclavian steal syndrome: value of the 2D time-of-flight "localizer" sign. AJR Am J Roentgenol. 185(4):1069-73, 2005
                                                                              6. Bitar R et al: MR angiography of subclavian steal syndrome: pitfalls and solutions. AJR Am J Roentgenol. 183(6):1840-1, 2004