Right subclavian double steal syndrome: a case report

We report on a 73-year-old male patient who presented at our hospital for the evaluation of dizziness and episodes of syncope. Angiography and color Doppler examinations documented the double syndrome as retrograde flow in the right vertebral artery and the right carotid artery.Constituting an indication for surgical correction, his condition was managed with the performance of carotid-carotid extra-anatomic bypass for the permanent reestablishment of antegrade blood flow in the vascular network supplying the brain. Carotid-carotid extra-anatomic bypass was a good option for our patient, since he remains symptom free after one year of follow up.Symptomatic atherosclerotic occlusive disease of the innominate artery is a relatively infrequent condition when compared with other manifestations of atherosclerosis causing flow-limiting effects and comprising less than 2% of all extracranial causes of cerebrovascular insufficiency [1]. Inflow obstruction of the right subclavian and common carotid arteries poses significant risks since right cerebral and right upper limb arterial blood supply depends on collateral networks which may not suffice in the presence of increased demand, promoting the appearance of neurologic deficits of varying degrees. Clinical presentation ranges from asymptomatic stenosis to more ominous forms of vascular compromise and subclavian steal syndrome manifesting with transient cerebral ischemia and ischemic arm symptoms. Although it was initially believed that the presence of subclavian stenotic or occlusive disease was associated with cerebral ischemia and neurologic deficits related to vertebrobasilar hypoperfusion, this opinion has been challenged and the prerequisite for the development of symptoms is the presence of disease in other extracranial vessels supplying the brain [2]. This observation is due to the relatively small contribution of the vertebral arteries to cerebral blood flow; a fact that has been demonstrated experimentally with no