ENDOVASCULAR TREATMENT FOR VERTEBRAL-SUBCLAVIAN STEAL SYNDROME DUE TO OBSTRUCTION OF THE PROXIMAL SUBCLAVIAN ARTERY TWO CASE REPORTS

Introduction. Obstruction of the prevertebral subclavian artery (PSA) is an important cause of cerebro-vascular disease with an extracranial origin. We report our experience in the endovascular treatment of two patients with obstruction of the PSA accompanied by symptomatic vertebral-subclavian steal syndrome. Case reports. Case 1: a 64-year-old male, admitted to hospital due to right-side parietal-occipital stroke. Doppler ultrasound recording of the supra-aortic trunks revealed complete obstruction of the right internal carotid and reversed flow in the left vertebral artery. The MR angiography scan showed occlusion of the left PSA. Case 2: a 75-year-old male who had undergone surgery 10 years before to perform a thromboendarterectomy of the right internal carotid artery, with no new neurological events since then. The patient had suffered recurrent syncopes during the previous month. The arteriography of the supra-aortic trunks confirmed the patency of the right internal carotid artery, without restenosis. Obstruction of the PSA was also observed, which was conditioning a vertebral-subclavian steal syndrome. By means of an ipsilateral humeral approach, in each case the lesion was recanalised and an 8 x 37 mm expandable-balloon stent was placed in the PSA, with good results in the follow-up angiography. In both cases there were no complications of a neurological ischaemic nature or in the upper limb in the post-operative period. In control tests using cranial tomography and Doppler ultrasound recording of the supra-aortic trunks carried out at one, three and six months, orthograde flow was found in the vertebral artery. Conclusions. Endovascular treatment of lesions to the PSA that are accompanied by vertebral-subclavian steal syndrome is an effective therapeutic option, even in cases of complete obstruction.