Common carotid artery occlusion with partial subclavian steal syndrome

Case contributed by Alzahrani Adel Ahmad S

Presentation

The patient mainly complains and suffers from cough and shortness of breath.

Patient Data

Age: 60 years
Gender: Male

The left side has shown an acute thrombus causing total blockage throughout the common carotid artery from proximal to distal part. 

Huge collateral has been spotted on and chased to be found feeding the internal carotid artery. 

The left vertebral artery has demonstrated "rabbit-shaped" spectral trace, which indicates partial subclavian steal syndrome. 

Left subclavian artery proximally has an elevated peak systolic velocity to 370 cm/s.

Case Discussion

A 60-year-old male patient has turned up for Carotid Duplex assessment. The patient has presented walking with full control. No previous images were taken. The patient has had no injury and takes his medication as instructed. The study has demonstrated right common carotid artery occlusion. During the assessment left vertebral artery waveform has shown a different waveform than usual. Normal vertebral artery waveform appears as low resistance. In this case, vertebral artery appeared as in "rabbit shape" which does indicate partial subclavian steal syndrome. 

As this finding leads to further images of the subclavian artery, it has been found that the ipsilateral subclavian artery has severe stenosis, giving an early sign of complete subclavian steal syndrome.

Subclavian steal is known as retrograde blood flow in the vertebral artery that indicates whether proximal ipsilateral subclavian artery stenosis or total occlusion. 

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Case information

rID: 64324
Published: 12th Jan 2019
Last edited: 12th Jan 2019
System: Vascular
Inclusion in quiz mode: Included
Institution: king Abdullah medical city

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