1/26. Endoluminal stenting for subclavian artery stenosis in Takayasu's arteritis.We describe a patient with Takayasu's arteritis (type I): occlusion of all large vessels of the aortic arch except the left subclavian artery which was, however, almost completely occluded, resulting in a characteristic subclavian steal syndrome. Elective left main subclavian artery balloon angioplasty followed by endoluminal stenting was performed with excellent results. After prolonged immunosuppressive treatment, at the 12-month follow-up there was no evidence of restenosis. In selected patients with Takayasu's arteritis and subclavian stenosis, elective endoluminal stenting can be used as a definitive procedure or as a bridge to surgical revascularization.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/26. Symptomatic subtotal occlusion of the innominate artery treated with balloon angioplasty and stenting.PURPOSE: To report the endovascular treatment of a subtotal occlusion of the innominate artery giving rise to subclavian steal syndrome. methods AND RESULTS: A 60-year-old man in general good health was admitted to the hospital for sudden onset of amaurosis in the right eye. thrombosis of the central retinal artery was diagnosed. physical examination, color flow duplex imaging, and aortic arch angiography showed a subtotal occlusion of the innominate artery with right subclavian steal syndrome. One month later, balloon dilation and stenting of the innominate artery was performed through a right axillary access without cerebral protection. The innominate artery was recanalized with correction of the steal syndrome and restoration of the right radial pulse; no complications occurred. Twelve months later, color flow duplex sonography confirmed innominate stent patency and antegrade flow in the right vertebral artery. CONCLUSIONS: Our experience supports the view that percutaneous endovascular techniques are appropriate and are the preferred treatment for lesions of the supra-aortic vessels. Continued surveillance will determine their long-term durability.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/26. A pitfall of neck vessels Doppler ultrasound: left subclavian artery occlusion without vertebral steal syndrome.In most cases, ostial occlusion of the subclavian artery induces a reversal of the blood flow in the ipsilateral vertebral artery. This hemodynamic diversion is obviously brought out by Doppler ultrasound of the neck vessels. Nevertheless, when the subclavian ostial lesions are less severe or in case of anatomical variations, the alterations of the vertebral flux are more discrete. An accurate Doppler examination is then required to avoid pitfalls. In the light of a particularly complex case, we reviewed the Doppler signs of vertebral blood flow in normal conditions and in patent or less obvious subclavian steals.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
4/26. Ocular pulse amplitude in a case of innominate steal syndrome.PURPOSE: To report an inter-eye difference of the ocular pulse amplitude (OPA) in a case of innominate steal syndrome, as measured by recording applanation tonometry. methods: OPA was measured in a 49-year-old male before and after percutaneous transluminal angioplasty of the innominate artery. RESULTS: Before dilation of the stenotic innominate artery, OPA was 2.00 ( /- 0.49) mm Hg in the right and 3.46 ( /- 0.53) mm Hg in the left eye. After dilation, OPA was 3.26 ( /- 0.51) mm Hg in the right eye and 3.25 ( /- 0.99) mm Hg in the left eye. CONCLUSION: Recording applanation tonometry may be useful for identifying occlusive disease of extracranial vessels in an office setting.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/26. Acute thrombotic subclavian artery occlusion treated with a new rotational thrombectomy device.PURPOSE: To report the use of a new rotational thrombectomy device for percutaneous thrombectomy of an acutely occluded subclavian artery. CASE REPORT: A 71-year-old woman with a history of multivessel coronary disease complained of sudden onset of pain at rest and paleness of the left arm. Duplex ultrasound showed a localized thrombotic occlusion of the postvertebral subclavian artery and another at the bifurcation of the brachial artery. After angiographic confirmation, the subclavian artery was recanalized with an 8-F Rotarex device via a percutaneous transfemoral access; the bifurcation of the brachial artery was recanalized by local thrombolysis (50 mg rtPA) because the thrombectomy device was too short to reach the occlusion. Follow-up examinations up to 1 year have shown normalized perfusion of the left arm. CONCLUSIONS: This new thrombectomy device is a useful tool for the percutaneous treatment of acute occlusion in the brachiocephalic arteries.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/26. Bilateral subclavian steal associated with severe coarctation of the thoracic aorta and an aberrant right subclavian artery.A 10-year-old girl having bilateral subclavian steal associated with severe coarctation of the thoracic aorta and an aberrant right subclavian artery was found, on admission, to have no difference between upper and lower extremity blood pressure, but echocardiography revealed severe thoracic aorta coarctation and systolic blood pressure in the carotid arteries exceeding 200 mmHg estimated by Doppler ultrasonography. magnetic resonance imaging and angiography demonstrated bilateral subclavian steal without esophageal compression. We reconstructed the aortic arch using the left subclavian artery and a reversed Blalock-Park procedure, then repaired the coarctation with a 14 mm woven double velor vascular graft. The girl was symptom-free following uncomplicated recovery from surgery. Doppler ultrasonography 2 weeks after surgery showed the pressure gradient across the aortic arch had decreased from 180 mmHg to 60 mmHg. This residual gradient at the anastomosis between the ascending aorta and left subclavian artery may improve as native vessels grow.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/26. Intracranial haemodynamics in Takayasu's arteritis.The cerebral circulation was assessed in two cases of Takayasu's arteritis by angiography of the aortic arch, cerebral blood flow single photon emission computed tomography (SPECT) and transcranial Doppler sonography (TCD). In both cases, disease of the major brachiocephalic arteries affected flow in the vertebrobasilar system and circle of willis. basilar artery flow was permanently reversed in one case, with vertebrovertebral shunting and subclavian steal. In the other case, focally reduced cerebral hemisphere flow resulted from watershed between vascular territories. The complex collateral and haemodynamic changes produced by multi-vessel involvement in Takayasu's arteritis suggest that therapeutic approaches should be based on assessment of end-organ perfusion rather than on structural angiographic changes.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/26. Stenting of a large thrombus-containing subclavian artery stenosis using a distal protection device.Atheromatous obstructive lesions of the arch vessels that contain thrombi are at high risk for distal embolization during angioplasty. This can lead to catastrophic neurological complications. We report a case of acute-on-chronic ischemia of the left upper limb due to thrombus-containing subclavian artery stenosis. After placement of an intravascular filter device, angioplasty and stent implantation successfully relieved the stenosis without any complications.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/26. Imaging diagnosis of subclavian steal syndrome secondary to takayasu arteritis affecting a left-side subclavian artery.takayasu arteritis (TA) is a rare form of large-vessel, chronic, occlusive vasculitis. It involves mainly aorta and its main branches, causing stenosis and/or obstruction. Its frequency has been estimated at 2.9 cases per 1 million people. Epidemiologically, it is found principally in young female patients and is more prevalent in asia and latin america. When there is severe stenosis or occlusion in subclavian artery, the phenomenon of subclavian steal syndrome (SSS) occurs, which usually causes symptoms of the vertebrobasilar territory because blood supply to the arm is sustained by reversal of flow in ipsilateral vertebral artery. We describe a case of SSS thought to be due to TA in a Mexican woman. Doppler ultrasound of neck vessels showed retrograde flow in left vertebral artery during systole. Digital subtraction angiography confirmed 30% stenosis of left subclavian artery with filling of left vertebral artery in retrograde direction. In presenting this case, we carried out a brief review of TA, main features in imaging diagnosis of SSS, and the infrequently reported association of TA with SSS.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/26. Takayasu's arteritis: case report of a patient with recurrent subclavian steal syndrome.Takayasu's arteritis is a chronic inflammatory disease of unknown origin in which cell-mediated inflammation involves large arteries progressing from the adventitia to the intima, until the lumen of the vessel is narrowed. Here we report a case of a 48-year-old female patient who was diagnosed with Takayasu's arteritis 6 years ago. At that time, because of severe involvement of both the right and left carotid arteries, she underwent application of a Hemashield vascular prosthesis, including the ascending aorta, left common carotid artery, and right common carotid artery. Due to the fact that there were also bilateral subclavian artery stenoses, the application of the prosthesis induced bilateral subclavian steal syndrome. This year she developed stenosis of the prosthesis and the bilateral subclavian steal syndrome disappeared until she underwent percutaneous transluminal angioplasty, which restored cerebral flow through the carotid arteries after which the subclavian steal syndrome reappeared.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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