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Case Report
Cerebral angiography in anterior circulation ischemic stroke with bilateral subclavian artery occlusion in subclavian steal syndrome: A case report and literature review
1 Clinical Associate Professor, Division of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine, Hasanuddin University, Brain Centre, Dr. Wahidin Sudirohusodo General Hospital and Hasanuddin University Teaching Hospital, Jl. Perintis Kemerdekaan KM 11, Makassar, South Sulawesi 90245, Indonesia
2 Department of Neurology, Faculty of Medicine, Hasanuddin University, Jl. Perintis Kemerdekaan KM 11, Makassar, South Sulawesi 90245, Indonesia
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Muhammad Yunus Amran
MD, PhD, FIPM, FINR, FINA, Neurologist and Consultant of Neurointerventionist, Lecturer and Clinical Associate Professor, Division of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine, Hasanuddin University, Brain Centre, Dr. Wahidin Sudirohusodo General Hospital and Hasanuddin University Teaching Hospital, Jl. Perintis Kemerdekaan KM 11, Makassar, South Sulawesi 90245,
Indonesia
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Article ID: 101475Z01MA2024
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Amran MY, Norwanto DA. Cerebral angiography in anterior circulation ischemic stroke with bilateral subclavian artery occlusion in subclavian steal syndrome: A case report and literature review. Int J Case Rep Images 2024;15(2):76–80.ABSTRACT
Introduction: Subclavian steal syndrome (SSS) is a hemodynamic phenomenon that occurs when a total occlusion in the subclavian artery (SA) proximal to the vertebral artery (VA) causes retrograde flow in the ipsilateral VA. Subclavian steal syndrome with total occlusion of bilateral SA is a very rare case.
Case Report: A 60-year-old woman reported experiencing sudden weakness on the right side of her body for eight days. Previously, the patient often felt shaky and cramped in his right and left hands. After a head computed tomography (CT) without contrast was performed, an infarct was found in the left centrum semiovale, left corona radiata, left posterior and anterior cornu periventricular, and right side of the pons. After cerebral digital subtraction angiography (C-DSA) was carried out, total occlusion of the bilateral SA was found, stenosis of the left M1 segment of the middle cerebral artery (MCA) branch.
Conclusion: Bilateral total occlusion of the SA is a very rare case and has rarely been reported before. In several studies, cases of unilateral SA occlusion resulted in SSS which provides an illustration of the reverse mechanism of blood vessel flow from the contralateral side of the occlusion. This backflow usually occurs in the contralateral vertebral artery. However, in this case, bilateral SA occlusion occurred so that there was no backflow mechanism in the VA. As compensation for the vascularization of the posterior circulation, collateral formation occurs from the external carotid artery (ECA) to the VA. However, this process causes a supply of blood flow to the anterior circulation, resulting in an anterior ischemic stroke.
Keywords: Anterior ischemic stroke, Cerebral digital subtraction angiography (C-DSA), Subclavian steal syndrome (SSS), Total subclavian artery occlusion
SUPPORTING INFORMATION
Author Contributions
Muhammad Yunus Amran - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Dwi Atmaji Norwanto - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Muhammad Yunus Amran et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
