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Subclavian steal syndrome

Subclavian steal syndrome in conjunction with occlusion of the proximal segment of the right subclavian artery, 1.5 T.

This 41 year old male presented with vertigo and ataxia, associated with claudication of the right arm.
Fig.1 The early arterial DSA image (left) of the aortic arch shows occlusion of the right subclavian artery at its origin. Retrograde opacification of the right vertebral artery is seen in the late phase (right).
Fig.2 The DSA images after selective injection of the left vertebral artery, show reversal of flow in the right vertebral artery and late opacification of the right subclavian artery distal to the occlusion.
Fig.3 Coronal MIP reconstruction of the cervical vertebral arteries from a 3D TOF (with the TONE option) MRA acquisition data set. This acquisition was performed with a cranial presaturation slab, which saturates spins that enter the acquisition volume cranially, therefore the right vertebral artery is not visualized. Visualization of the left vertebral artery only (arrows).
Fig.4 The same acquisition was repeated without a presaturation slab. Spins entering the acquisition volume either caudally or cranially will contribute to the intravascular signal, consequently both vertebral arteries are shown (arrows), giving evidence for flow reversal in the right vertebral artery.

 

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Fig. 1

Subclavian steal syndrome, Fig. 1
Subclavian steal syndrome, Fig. 2
Subclavian steal syndrome, Fig. 3
Subclavian steal syndrome, Fig. 4