From the Guidelines
Steal syndrome, also known as Subclavian steal syndrome, is a condition characterized by symptomatic posterior cerebral or cerebellar ischemia caused by subclavian artery stenosis or occlusion, leading to reversal of blood flow in the vertebral artery. This condition occurs when there is a significant stenosis or occlusion of the subclavian artery, which supplies blood to the arm, causing a decrease in blood pressure in the arm. As a result, blood is "stolen" from the vertebral artery, which supplies blood to the brain, to supply the arm, leading to ischemia in the posterior cerebral or cerebellar circulation [ 1 ].
Key Points
- Symptoms of Subclavian steal syndrome include syncope, vertigo, and arm fatigue or claudication [ 1 ].
- Management options for Subclavian steal syndrome include extra-anatomic carotid-subclavian bypass and percutaneous endovascular angioplasty and stenting, depending on the patient's risk factors and clinical presentation [ 1 ].
- The choice of treatment should be individualized based on the patient's specific needs and medical history [ 1 ].
Treatment Options
- Extra-anatomic carotid-subclavian bypass is a reasonable option for patients with symptomatic posterior cerebral or cerebellar ischemia caused by subclavian artery stenosis or occlusion, in the absence of clinical factors predisposing to surgical morbidity or mortality [ 1 ].
- Percutaneous endovascular angioplasty and stenting is a reasonable option for patients with symptomatic posterior cerebral or cerebellar ischemia caused by subclavian artery stenosis, who are at high risk of surgical complications [ 1 ].
From the Research
Definition and Causes of Steal Syndrome
- Steal syndrome is a vascular disorder characterized by the inappropriate alterations of blood flow through adjacent collateral blood vessels to compensate for ischemia in organs with severely reduced or lost blood flow 2.
- It can be caused by high fistula flow, steal phenomenon, inflow, outflow or anastomotic stenosis, or a combination of these causes 3.
- Subclavian steal syndrome (SSS) is a specific type of steal syndrome that occurs when there is a steno-occlusive lesion of the proximal subclavian artery, causing retrograde flow in the vertebral artery away from the brain stem 4, 5.
Symptoms and Diagnosis of Steal Syndrome
- Symptoms of steal syndrome can include paroxysmal vertigo, drop attacks, arm claudication, and neurological signs and symptoms such as numbness, tingling, and blurry vision 4, 6, 5.
- Diagnosis of steal syndrome is largely based on clinical features and non-invasive studies, such as Doppler ultrasound, but may require confirmation by CT or MR angiography 3, 4.
- In some cases, angiography may be necessary to determine the underlying cause of the steal syndrome 3, 2.
Treatment Options for Steal Syndrome
- Treatment options for steal syndrome include flow-reducing procedures, distal revascularization interval ligation, and simple distal arterial ligation 3.
- In cases of subclavian steal syndrome, conservative treatment is often the initial approach, with surgery or percutaneous angioplasty and stenting reserved for refractory symptomatic cases 4, 5.
- Medical management with steroids and methotrexate may be effective in cases of Takayasu's vasculitis presenting with subclavian steal syndrome 6.